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©2013 UpToDate ® Print Email Drug regimens for prophylaxis against malaria in children Drug Tablet size Dose Frequency* Initiation (time before first exposure to malaria) Discontinuation (time after last exposure) Areas with chloroquine-resistant Plasmodium falciparum Atovaquone-proguanil (Malarone) Pediatric tablet: 62.5 mg atovaquone and 25 mg proguanil Adult tablet: 250 mg atovaquone and 100 mg proguanil Body weight 5-8 kg, 1/2 pediatric tablet daily; Body weight 9-10 kg, 3/4 pediatric tablet daily; Body weight 11-20 kg, 1 pediatric tablet daily; Body weight 21-30 kg, 2 pediatric tablets daily; Body weight 31-40 kg, 3 pediatric tablets daily; Body weight ≥41 kg, 1 adult tablet daily Once daily 1-2 days 7 days Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) Body weight ≤9 kg, one-eighth tablet or 5 mg salt per kg Body weight 10-19 kg, one-quarter tablet Body weight 20-30 kg, one-half tablet Body weight 31-45 kg, three-quarters tablet Body weight ≥46 kg, 1 tablet Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg ≥8 years old, 2 mg per kg of body weight orally once daily (maximum dosage, 100 mg/day) Once daily 1-2 days 4 weeks Areas with chloroquine-sensitive Plasmodium falciparum Chloroquine phosphate (Aralen and generic agents) 500 mg salt (300 mg base) 8.3 mg salt per kg of body weight (5 mg base per kg of body weight) Once weekly 1-2 weeks 4 weeks Hydroxychloroquine sulfate (Plaquenil) 400 mg salt (310 mg base) 6.5 mg salt per kg of body weight (5 mg base per kg of body weight) Once weekly 1-2 weeks 4 weeks Atovaquone-proguanil (Malarone) (as in 1st row above) (as in 1st row above) Once daily 1-2 days 7 days Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) (as in 2nd row above) Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg ≥8 years old, 2 mg per kg of body weight orally once daily (maximum dosage, 100 mg/day) Once daily 1-2 days 4 weeks Areas with P. vivax Primaquine phosphate for primary prophylaxis (off-label use) 26.3 mg salt (15 mg base) 0.8 mg per kg of body weight salt (0.5 mg per kg of body weight base) Once daily 1-2 days 7 days Chloroquine phosphate (Aralen and generic agents) 500 mg salt (300 mg base) 8.3 mg salt per kg of body weight (5 mg base per kg of body weight) Once weekly 1-2 weeks

Primaquine phosphate for primary prophylaxis (off-label use) 26.3 mg salt (15 mg base) 0.8 mg per kg of body weight salt (0.5 mg per kg of body weight base) Once daily 1-2 days 7 days Chloroquine phosphate (Aralen and generic agents) 500 mg salt (300 mg base) 8.3 mg salt per kg of body weight (5 mg base per kg of body weight) Once weekly 1-2 weeks 4 weeks Hydroxychloroquine sulfate (Plaquenil) 400 mg salt (310 mg base) 6.5 mg salt per kg of body weight (5 mg base per kg of body weight) Once weekly 1-2 weeks 4 weeks Atovaquone-proguanil (Malarone) (as in 1st row above) (as in 1st row above) Once daily 1-2 days 7 days Mefloquine hydrochloride (Lariam and generic agents) 250 mg salt (228 mg base) (as in 2nd row above) Once weekly 3 weeks preferable; 2 weeks acceptable 4 weeks Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) 100 mg ≥8 years old, 2 mg per kg of body weight orally once daily (maximum dosage, 100 mg/day) Once daily 1-2 days 4 weeks Presumptive antirelapse therapy (to prevent relapse due to P. vivax or P. ovale) Primaquine phosphate 26.3 mg salt (15 mg base) 0.8 mg per kg of body weight salt (0.5 mg per kg of body weight base) Once daily As soon as possible following exposure for which another prophylactic drug taken 14 days * 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.