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The choice of malaria prevention drugs for travelers depends on several factors, including the specific destination, drug resistance patterns in that region, duration of travel, and individual patient factors like age, pregnancy status, and other medical conditions. It's crucial to consult a doctor or a travel clinic 4 to 6 weeks before your trip to get a personalized recommendation.

Here are some commonly prescribed malaria prevention drugs:

• Atovaquone/Proguanil (Malarone):

  • Timing: Start 1-2 days before travel, take daily during travel, and continue for 7 days after leaving the malaria-endendemic area.
  • Advantages: Good for last-minute travelers and shorter trips due to the shorter post-travel dosing period. Generally well-tolerated with uncommon side effects. Pediatric tablets are available. It is highly effective against drug-resistant Plasmodium falciparum strains.
  • Side Effects: Most common are stomach pain, nausea, vomiting, and headache. These can often be lessened by taking the medication with food. Less common side effects include anxiety, palpitations, hair loss, and mouth swelling or redness.
  • Contraindications: Not recommended for pregnant or breastfeeding women, or individuals with severe renal impairment.

• Doxycycline:

  • Timing: Begin 1-2 days before travel, take daily during travel, and continue for 4 weeks after leaving.
  • Advantages: Usually the most affordable option. Can also prevent other infections like rickettsiae and leptospirosis, making it suitable for those planning activities like hiking and camping.
  • Side Effects: Can cause upset stomach, increased sensitivity to the sun, and vaginal yeast infections in women.
  • Contraindications: Should not be taken by pregnant women, breastfeeding women, or children younger than 8 years old.

• Mefloquine:

  • Timing: Start 1-2 weeks before travel, take weekly during travel, and continue for 4 weeks after leaving.
  • Advantages: Can be used by pregnant women (especially in the second and third trimesters) and is a preferred option for longer trips (e.g., 2 months).
  • Side Effects: Can include dizziness, sleep disturbances, and neuropsychiatric reactions (e.g., anxiety, depression, psychosis, seizures).
  • Contraindications: Should not be used by individuals with a history of seizures, severe heart problems, or psychiatric conditions. Not a good choice for last-minute travelers due to the longer lead-time required before travel.

• Primaquine:

  • Timing: Start 1-2 days before travel, take daily during travel, and for 7 days after leaving.
  • Advantages: Highly effective for preventing P. vivax malaria. Good for shorter and last-minute trips.
  • Side Effects: Can cause an upset stomach.
  • Contraindications: Cannot be used in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, or by pregnant or breastfeeding women (unless the infant has been tested for G6PD deficiency). G6PD testing is required before starting this medication.

• Tafenoquine (Arakoda):

  • Timing: Taken daily for 3 days before travel, once a week during travel, and then one dose seven days after exiting the area.
  • Advantages: A newer drug for adults aged 16 years or older.
  • Side Effects: Can cause an upset stomach.
  • Contraindications: Not for use in individuals younger than 16, pregnant or breastfeeding women, those with G6PD deficiency, or those with a history of psychiatric disorders.

• Chloroquine:

  • Timing: Start 1-2 weeks before travel, take weekly during travel, and continue for 4 weeks after leaving.
  • Advantages: Can be used safely in all trimesters of pregnancy and in children of all ages.
  • Side Effects: Relatively few adverse effects at usual doses; gastrointestinal issues are most common. Serious side effects are rare but can include retinopathy and cardiomyopathy with prolonged or high-dose use.
  • Limitations: No longer effective against P. falciparum, the most common and dangerous type of malaria parasite, due to widespread resistance. It is only recommended for travel to areas with chloroquine-sensitive malaria (e.g., some parts of Central America, Haiti, and the Dominican Republic).

In addition to medication, it is essential to use personal protective measures against mosquito bites, such as insect repellent, long clothing, and insecticide-treated bed nets, as malaria pills are not 100% effective.