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©2013 UpToDate ® Print Email Drug regimens for prophylaxis against malaria in adults Drug Tablet size Dose Frequency* Initiation (time before first exposure to malaria) Discontinuation (time after last exposure) Use in pregnancy Areas with chloroquine-resistant Plasmodium falciparum Atovaquone-proguanil (Malarone) 250 mg atovaquone and 100 mg proguanil One tablet orally Once daily 1-2 days 7 days No; insufficient data on use in pregnancy Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) One tablet orally Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Yes Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg One tablet orally Once daily 1-2 days 4 weeks No; teratogenic Areas with chloroquine-sensitive Plasmodium falciparum Chloroquine phosphate (Aralen and generic agents) 500 mg salt (300 mg base) One tablet orally Once weekly 1-2 weeks 4 weeks Yes Hydroxychloroquine sulfate (Plaquenil) 400 mg salt (310 mg base) One table orally Once weekly 1-2 weeks 4 weeks Yes Atovaquone-proguanil (Malarone) 250 mg atovaquone and 100 mg proguanil One tablet orally Once daily 1-2 days 7 days No; insufficient data on use in pregnancy Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) One tablet orally Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Yes Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg One tablet orally Once daily 1-2 days 4 weeks No; teratogenic Areas with P. vivax Primaquine phosphate (appropriate prophylaxis for short duration travel to areas with principally P. vivax) 26.3 mg salt (15 mg base) Two tablets orally Once daily 1-2 days 7 days No; contraindicated because of potential toxicity for fetal erythrocytes Chloroquine phosphate (Aralen and generic agents) 500 mg salt (300 mg base) One tablet orally Once weekly 1-2 weeks 4 weeks Yes Hydroxychloroquine sulfate (Plaquenil) 400 mg salt (310 mg base) One tablet orally Once weekly 1-2 weeks 4 weeks Yes Atovaquone-proguanil (Malarone) 250 mg atovaquone and 100 mg proguanil One tablet orally Once daily 1-2 days 7 days No; insufficient data on use in pregnancy Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) One tablet orally Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Yes Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg One tablet orally Once daily 1-2 days 4 weeks

Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) One tablet orally Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Yes Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg One tablet orally Once daily 1-2 days 4 weeks No; teratogenic Presumptive antirelapse therapy (to prevent relapse due to P. vivax or P. ovale) Primaquine phosphate 26.3 mg salt (15 mg base) Two tablets orally Once daily As soon as possible following exposure for which another prophylactic drug taken 14 days No; contraindicated because of potential toxicity for fetal erythrocytes * Drugs administered once daily should be taken at the same time each day; drugs administered once weekly should be taken on the same day each week. 1. Hill, DR, Ericsson, CD, Pearson, RD, et al. The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1499. 2. Freedman, DO. Clinical practice. Malaria prevention in short-term travelers. N Engl J Med 2008; 359:603-612.