Anti-malarial chemoprophylaxis
For effective prevention against malaria, travellers should first be aware of the risk of contracting malaria. Adopting measures to prevent being bitten by mosquitoes is still the best and the first line of defense. The preventive measures include wearing long-sleeved clothes and long trousers when going out at night, applying effective insect repellent (containing DEET) over exposed parts of the body, and staying in accommodation with air conditioning or mosquito screens and nets. Clothing and nets impregnated with permethrin will make them more effective in avoiding mosquito bites. Anti-mosquito sprays or insecticide dispensers could also be used indoors. These simple first line measures will help to prevent malaria and other mosquito-borne diseases such as yellow fever, dengue fever and Japanese encephalitis.
There is at present no effective vaccine against malaria. Depending on individual travel itinerary, antimalarial pills may be required. There are five drugs commonly used in antimalarial chemoprophylaxis. The drug of choice is determined by the species and patterns of drug resistance of the malaria in the destinations and the current physical condition and past medical history of the traveller.
This drug should be taken one week before and throughout the journey, then continue for 4 weeks after leaving the area.
Dose : 5mg base per kg once a week
| <4 mths | 25mg | 4-11 mths | 50mg |
| 1-2 yrs | 75mg | 3-4 yrs | 100mg |
| 5-7 yrs | 125mg | 8-10 yrs | 150mg |
| 11-13 yrs | 250mg | >14 yrs | 300mg |
| Adverse effects | |
| Nausea, headache, dizziness | |
| Rare: | skin eruption, blurred vision, pruritus, impaired hearing, convulsion, blood disorder |
| Contraindication: | psoriasis, epileptic, G6PD deficiency, allergy to quinine compounds. |
This drug should be taken one day before and throughout the journey, then continue for 4 weeks after leaving the area.
Dose: 3mg per kg daily
| <8mths | 25mg | 8mths-3yrs | 50mg |
| 4-7 yrs | 75mg | 8-10yrs | 100mg |
| 11-13 yrs | 150mg | >14 yrs | 200mg |
| Adverse effects | |
| Nausea, diarrhea, mouth ulcers | |
| Rare: | haematuria, hair loss |
| Contraindication: | severe renal impairment, drug allergy history |
This drug should be taken one week before and throughout the journey, then continue for 4 weeks after leaving the area.
Dose : 5mg per kg once a week
| <3mths | not recommended | 3-23 mths | 1/4 tab |
| 2-3 yrs | 1/3 tab | 4-7 yrs | 1/2 tab |
| 8-10 yrs | 3/4 tab | >11 yrs | 1 tab |
(one tablet contains 250mg)
| Adverse effects | |
| Nausea, dizziness, headache, syncope, insomnia, extrasystoles, diarrhea | |
| Rare: | severe neuropsychiatric syndrome |
| Contraindication: | aircrew, epileptic, psychiatric disorders, first 3 months of pregnancy, allergy to quinine compound |
This drug should be taken one day before and throughout the journey, then continue for 4 weeks after leaving the area.
Dose : 1.5mg salt per kg daily
| <8 yrs | contraindicated | 8-10yrs | 50mg |
| 11-13 yrs | 75mg | >14 yrs | 100mg |
| Adverse effects | |
| Nausea, diarrhea, candida vaginitis | |
| Rare: | skin photosensitivity |
| Contraindication: | pregnancy, allergic to tetracycline group of medication |
5) Atouaqune & Proguail Hydcochloride
This drug should be taken one day before and daily throughout the journey in affected area, then countinuing for 7 days after leaving the area.
Adult dose contains 250mg of atovaquone and 100mg of proguanil hydrochloride :
Dose : 40kg, 1 tab per day
| <11 kg | Contraindicated | 31-40kg | 3 paediatric tab |
| 11-20 kg | 1 paediatric tab | >40 kg | 1 adult tab |
| 21-30 kg | 2 paediatric tab |
| Adverse effects | |
| Abdominal pain, nausea, vomiting, headache, diarrhoea, mouth ulcers | |
| Rare: | hair loss, haematuria |
| Contraindication: | Severe renal impairment, allergic to the drug compounds |
The traveller should strictly follow the guidance of physician in order to achieve the maximal protective effect offered by antimalarial chemoprophylaxis. If the traveller experiences severe adverse effects of the drugs during travel, which are so severe that continuation of prophylaxis becomes difficult, he should seek local medical advice.