Drugs Used to Prevent Malaria

Atovaquone/proguanilAtovaquone/proguanil

In all areas

Begun 1–2 days before travel and continued daily during the stay and for 7 days after leaving

Contraindicated in pregnant and breastfeeding (chestfeeding) patients

ChloroquineChloroquine

Only in areas with chloroquine-sensitive Plasmodium

Begun 1–2 weeks before travel and continued weekly during the stay and for 4 weeks after leaving

Doxycycline Doxycycline

In all areas

Begun 1–2 days before travel and continued during the stay and for 4 weeks after leaving

Hydroxychloroquine Hydroxychloroquine

An alternative to chloroquine only in areas with An alternative to chloroquine only in areas withchloroquine-sensitive Plasmodium

Begun 1–2 weeks before travel and continued during the stay and for 4 weeks after leaving

Mefloquine Mefloquine

In areas with mefloquine-sensitive Plasmodium

Begun ≥ 2 weeks before travel and continued during the stay and for 4 weeks after leaving

Contraindicated in patients with a history of depression, other psychologic problems, or seizures; not recommended for patients with cardiac conduction abnormalities

Primaquine Primaquine

For primary prophylaxis for brief travel in areas known to harbor mainly P. vivax

Begun 1 to 2 days before travel and continued daily during the stay and for 7 days after departure

Document that the G6PD level is normal before use

Contraindicated in people with G6PD deficiency and in pregnant and breastfeeding patients unless the breastfed infant has a normal G6PD level

For terminal prophylaxis to prevent relapse of infection in people with substantial exposure to or infection with P. vivax or P. ovale during travel

Given daily for 14 days after departure from endemic area. Document that the G6PD level is normal before use

Contraindications as above

TafenoquineTafenoquine

For primary prophylaxis in travelers to all areas ≥ 16 years of age

Given daily for 3 days before travel, once weekly during travel, and once 7 days after departure from endemic area

G6PD deficiency or unknown G6PD status; all patients should be tested for G6PD deficiency prior to use

Pregnant and breastfeeding patients unless the breastfed infant has a normal G6PD level; known hypersensitivity

Psychiatric adverse reactions have been observed

Use with caution in patients with a history of psychiatric illness

For terminal prophylaxis in people > 18 years of age with substantial exposure to or infection with P. vivax or P. ovale during travel