TABLE 52–2 Drugs for the prevention of malaria in travelers.1 1Recommendations may change, as resistance to all available drugs is increasing. See text for additional information on toxicities and cautions. For additional details and pediatric dosing, see CDC guidelines (phone: 877-FYI-TRIP; www.cdc.gov). Travelers to remote areas should consider carrying effective therapy (see text) for use if they develop a febrile illness and cannot reach medical attention quickly.
2Areas without known chloroquine-resistant P falciparum are Central America west of the Panama Canal, Haiti, Dominican Republic, Egypt, and most malarious countries of the Middle East. Malarone or mefloquine are currently recommended for other malarious areas except for border areas of Thailand, where doxycycline is recommended.
3For drugs other than primaquine, begin 1–2 weeks before departure (except 2 days before for doxycycline and Malarone) and continue for 4 weeks after leaving the endemic area (except 1 week for Malarone). All dosages refer to salts.
4Screen for glucose-6-phosphate dehydrogenase (G6PD) deficiency before using primaquine.
TABLE 52–3 Treatment of malaria.
Uncomplicated infections with chloroquine-resistant
Severe or complicated infections with P falciparum Coartem (artemether, 20 mg, plus lumefantrine, 120 mg), four tablets twice daily for 3 days
Artesunate,2 2.4 mg/kg IV, every 12 hours for 1 day, then daily for 2 additional days; follow with 7-day oral course of doxycycline or clindamycin or full treatment course of Coartem, Malarone, or mefloquine
Quinidine gluconate,4,5 10 mg/kg IV over 1–2 hours, then 0.02 mg/kg IV/min
Quinidine gluconate4,5 15 mg/kg IV over 4 hours, then 7.5 mg/kg IV over 4 hours every 8 hours Malarone, four tablets (total of 1 g atovaquone, 400 mg proguanil) daily for 3 days
Mefloquine, 15 mg/kg once or 750 mg, then 500 mg in 6–8 hours
Quinine sulfate, 650 mg 3 times daily for 3 days, plus doxycycline, 100 mg twice daily for 7 days, or clindamycin, 600 mg twice daily for 7 days
Artemether,3 3.2 mg/kg IM, then 1.6 mg/kg/d IM; follow with oral therapy as for artesunate
Quinine dihydrochloride,3–5 20 mg/kg IV, then 10 mg/kg every 8 hours 1All dosages are oral and refer to salts unless otherwise indicated. See text for additional information on all agents, including toxicities and cautions. See CDC guidelines (phone: 770-488-7788; www.cdc.gov) for additional information and pediatric dosing.
2Available in the United States only on an investigational basis through the CDC (phone: 770-488-7788).
3Not available in the USA.
4Cardiac monitoring should be in place during intravenous administration of quinidine or quinine. Change to an oral regimen as soon as the patient can tolerate it.
5Avoid loading doses in persons who have received quinine, quinidine, or mefloquine in the prior 24 hours.
G6PD, glucose-6-phosphate dehydrogenase.