1. Personal Protection Against Malaria avoidance of exposure to mosquitoes at their peak feeding times (usually dusk and dawn) and throughout the night use of insect repellents containing DEET (10–35%) or picaridin (7%; if DEET is unacceptable),suitable clothing, and insecticide-impregnated bed nets or other materials – Widespread use of bed nets treated with residual pyrethroids reduces the incidence of malaria in areas where vectors bite indoors at night

2. Table 203-8 Drugs Used in the Prophylaxis of Malaria DrugUsageAdult DoseComments Atovaquone/proguani l (Malarone) Prophylaxis in areas with chloroquine- or mefloquine- resistant Plasmodium falciparum 1 adult tablet PO Good for last-minute travelers; begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Side effects are uncommon. Contraindicated in persons with severe renal impairment (creatinine clearance rate <30 mL/min). It is not recommended for children weighing <5 kg, pregnant women, or women breast-feeding infants weighing <5 kg. Should be taken with food or a milky drink. Chloroquine phosphate (Aralen and generic) Prophylaxis only in areas with chloroquine-sensitive P. falciparum c 300 mg of base (500 mg of salt) PO once weekly Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas. Can be given in all trimesters of pregnancy. Patients taking hydroxychloroquine for rheumatologic conditions may not need to take an extra drug. May exacerbate psoriasis. Doxycycline (many brand names and generic) Prophylaxis in areas with chloroquine- or mefloquine- resistant P. falciparum c 100 mg PO qd Good for last-minute travelers; begin 1–2 days before travel to malarious areas. Least expensive among anti-malarial agents. Take daily at the same time each day while in the malarious areas and for 4 weeks after leaving such areas. Patients taking this for acne do not need to take an extra drug. Doxycycline also can prevent some additional infections (e.g., Rickettsiae and leptospirosis) and so it may be preferred by people planning to do lots of hiking, camping, and wading and swimming in fresh water. Doxycycline is contraindicated in children <8 years of age and in pregnant women. Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine. Risk of photosensitivity. Harrison’s Internal Medicine, 17 th ed. Global Health – Division of Parasitic Diseases. Centers for Disease Control and Prevention, updated Feb. 8, 2010.

3. Hydroxychloroquine sulfate (Plaquenil) An alternative to chloroquine for primary prophylaxis only in areas with chloroquine-sensitive P. falciparum c 310 mg of base (400 mg of salt) PO once weekly Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas. Hydroxychloroquine may exacerbate psoriasis. Mefloquine (Lariam and generic) Prophylaxis in areas with chloroquine-resistant P. falciparum 228 mg of base (250 mg of salt) PO once weekly Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas. Can be used in second and third trimester of pregnancy, also in first if there is no other option. Mefloquine is contraindicated in persons allergic to this drug or related compounds (e.g., quinine and quinidine) and in persons with active or recent depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures. Use with caution in persons with psychiatric disturbances or a history of depression. Mefloquine is not recommended for persons with cardiac conduction abnormalities. PrimaquineAn option for prophylaxis in special circumstances; used for presumptive antirelapse therapy (terminal prophylaxis) to decrease risk of relapses of P. vivax and P. ovale. 30 mg of base (52.6 mg of salt) PO qd for 14 days after departure from the malarious area Good for last-minute travelers; begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious areas and for 7 days after leaving such areas. This therapy is indicated for persons who have had prolonged exposure to P. vivax and/or P. ovale. It is the most effective medicine for preventing P. vivax and so it is a good choice for travel to places with > 90% P. vivax. Primaquine is contraindicated in persons with G6PD1 deficiency. It is also contraindicated during pregnancy and in lactation unless the infant being breast-fed has a documented normal G6PD level. Use in consultation with malaria experts. Harrison’s Internal Medicine, 17 th ed. Global Health – Division of Parasitic Diseases. Centers for Disease Control and Prevention, updated Feb. 8, 2010.