Version July 2025
| Drug | Tablet size | Dose | Frequency* | Initiation (time before first exposure to malaria) | Discontinuation (time after last exposure) | Additional comments |
| Drug regimens for primary prophylaxis¶Δ | ||||||
| Atovaquone-proguanil (Malarone) | Pediatric tablet:
Adult tablet:
| Body weight:
| Once daily | 1 to 2 days | 7 days | Cannot be used in patients with severe kidney impairment. Administer with food. |
| Doxycycline hyclate (Vibramycin, Vibra-Tabs, other brands, and generic agents); doxycycline monohydrate (Monodox, Adoxa, and generic agents) | 100 mg | ≥8 years old: 2.2 mg per kg of body weight orally once daily (maximum dose 100 mg/day) | Once daily | 1 to 2 days | 4 weeks | Doxycycline can also prevent other infections (such as rickettsial infections, leptospirosis). Gastrointestinal adverse effects include abdominal discomfort, nausea, vomiting. Photosensitivity reactions can occur. Avoid administration with calcium, magnesium, iron, or aluminum. |
| Mefloquine hydrochloride (Lariam and generic agents)Δ | 250 mg salt (228 mg base) | Body weight:
| Once weekly | 3 weeks preferable; 2 weeks acceptable | 4 weeks | Contraindicated for patients with neurologic and psychiatric disorders. Not recommended for patients with arrhythmia. |
| 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); max dose same as adult dose | Once weekly | 1 to 2 weeks | 4 weeks | Can exacerbate psoriasis. |
| 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); max dose same as adult dose | Once weekly | 1 to 2 weeks | 4 weeks | Can exacerbate psoriasis. |
| Primaquine phosphate§ (off-label use for short duration travel to areas with principally Plasmodium vivax¥) | 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); max dose same as adult dose | Once daily | 1 to 2 days | 7 days | Requires G6PD testing. May cause gastrointestinal upset; should be taken with food. |
| Presumptive antirelapse therapy (PART) 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); max dose same as adult dose | Once daily | Approach should be guided by agent used for primary prophylaxis‡ | 14 days | Requires G6PD testing. |
G6PD: glucose-6-phosphate dehydrogenase.
* 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.
¶ Chloroquine-resistant Plasmodium falciparum is widespread in endemic areas of Africa, Asia, Oceania, and South America.
Δ Mefloquine-resistant P. falciparum has been confirmed in Southeast Asia on the borders of Thailand with Burma (Myanmar) and Cambodia, in the western provinces of Cambodia, in the eastern states of Burma on the border between Burma and China, along the borders of Burma and Laos, and in southern Vietnam. For these destinations, prophylaxis options are atovaquone-proguanil, doxycycline, and tafenoquine.
◊ Chloroquine-sensitive P. falciparum exists in Haiti, the Caribbean, and in Central America west and north of the Panama Canal.
§ A quantitative G6PD test must be done to rule out G6PD deficiency prior to the first administration of primaquine or tafenoquine. Note that qualitative G6PD testing can miss those with moderate deficiency and is not sufficient to establish normal G6PD activity. Refer to UpToDate text for further discussion.
¥ P. vivax is the predominant species (>90%) in parts of Mexico, parts of Central America, Cambodia, North Korea, and South Korea.
‡ Refer to UpToDate text for PART indications. Travelers should take primaquine for 14 days after leaving a malaria-endemic area, concurrently with their primary prophylaxis medication. If atovaquone-proguanil is used for primary prophylaxis, travelers can take primaquine during the final 7 days of atovaquone-proguanil, and then for an additional 7 days. If chloroquine, doxycycline, or mefloquine are used for primary prophylaxis, prescribe primaquine for travelers to take during the last 2 weeks of postexposure prophylaxis. If concurrent administration of primary and terminal prophylaxis is not feasible, instruct travelers to take primaquine after completing their primary prophylaxis medication. PART is not needed if primaquine or tafenoquine is used as primary prophylaxis.
