Chemoprophylaxis

(Taking Antimalarial Medication)

Atovaquone/Proguanil / Doxycycline / Mefloquine
(Lariam)
Dose / One tablet daily
1-2 days before travel
Continued throughout travel
7 days afterwards / 100mg dose daily
1-2 days before travel
Continued throughout travel
4 weeks afterwards / One tablet weekly, always on the same day
One week before travel
4 weeks afterwards
Paediatric dose / Yes (11-40kg) / Not for children less than 12 years / Scored tablets need to be split
For children between 5kg-45kg
The clinical efficacy of recommended antimalarials / 98-100% / 92-100% / >90%
Side effects include:
Refer to the SPC for full details of the adverse events of each drug / Abdominal Pain, headache
Anorexia, cough, nausea, vomiting and diarrhoea. / Nausea, Diarrhoea, vomiting,
Photosensitivity, loss of appetite, dyspepsia and rash / Nausea, diarrhoea, vomiting,
Headaches, dizziness or vertigo, somnolence, sleep disturbances (insomnia, abnormal dreams) and abdominal pain.
Pregnancy / Lack of clinical data in human pregnancy means that the potential risk is unknown and that it should be avoided in these circumstances unless there is no suitable alternative. Breastfeeding: Excretion in breast milk therefore use is contraindicated in nursing mothers. / Contraindicated in pregnancy and nursing mothers. / Lack of clinical data in human pregnancy means that the potential risk is unknown and that it should be avoided in these circumstances unless there is no suitable alternative. Breastfeeding: Excretion in breast milk therefore use is contraindicated in nursing mothers.
Caution / Proguanil can delay the metabolism of the anticoagulant warfarin, resulting in bleeding.
In patients with severe renal impairment, alternative treatments should be recommended whenever possible.
Absorption of Malarone may be reduced un individuals with diarrhoea and vomiting
Concomitant use of tetracyclines, metoclopramide and especially rifabutin is associated with a significant reduction of plasma concentrations of Malarone / Permanent tooth discolouration may occur during tooth development (pregnancy, infancy and children under 12 years)
When patients are likely to be exposed to direct sunlight or UV light an exaggerated sunburn reaction can cause photosensitivity
The use of antibiotics may occasionally result in the overgrowth of non-susceptible organisms, including Candida
In patients with impaired hepatic function and renal impairment
Heartburn is common so the capsule should be taken with a full glass of water and preferably while standing or sitting upright
Alcohol may decrease the half-life of doxycycline / In severe renal or liver failure avoid if alternatives are available
Patients with a history of psychiatric disturbances, including depression
Avoid use in patients taking anti-convulsant therapy
Patients with heart rhythm defects and in those taking anti-arrhythmic agents