Society of Tropical Medicine & Infectious Diseases in India
- Determine whether malaria risk exists for the destination country.
If yes: Does the patient’s itinerary within that country put him or her at risk?
If yes: Recommend malaria chemoprophylaxis. - Several equally effective drugs of choice may be indicated. Ascertain which is best suited to the individual patient and itinerary.
- Educate on personal protection against arthropods.
Malaria chemoprophylaxis schedule
Formulating chemoprophylaxis for malaria requires knowledge of drug sensitivity pattern of the travelling area and travel plan. If the visit was planned early, then the drugs will be different from an unplanned visit.
| Drug | Area | When To start | When To stop | Dosage | Check-list |
| Chloroquine | Chloroquine sensitive areas | 1 week before visit | 4 weeks after return | 300mg base (500mg salt)/ week | For trips of short duration, some people would rather not take medication for 4 weeks after travel Not a good choice for last-minute travellers because drug needs to be started 1-2 weeks prior to travel |
| Mefloquine | Chloroquine resistant areas Sensitive to mefloquine |
2-3 weeks before visit | 4 weeks after return | 250mg / week | Cannot be used in patients with certain psychiatric conditions Cannot be used in patients with a seizure disorder Not recommended for persons with cardiac conduction abnormalities |
| Doxycycline | Effective in all areas | 1 day before visit | 4 weeks after return | 100 mg daily | Cannot be used by pregnant women and children <8 years old Increased risk of sun sensitivity Potential of getting an upset stomach from doxycycline |
| Atovaquone / Proguanil | Effective in all areas | 1-2 days before visit | 7 days after return | 250 mg / 100 mg | Cannot be used by women who are pregnant or breastfeeding a child less than 5 kg Cannot be taken by people with severe renal impairment more expensive than some of the other options (especially for trips of long duration) |
| Primaquine | Only for those with prolonged and extensive exposure to P. vivax or P. ovale |
1-2 days before visit | 7 days after return | 30 mg | Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency Cannot be used in patients who have not been tested for G6PD deficiency Cannot be used by pregnant women Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency This effectively excludes most short-term travellers |