Drugs (generic and trade name) for the treatment and prevention of malaria
Summary of information, including doses, for the antimalarial drugs routinely used in Canada
- ATOVAQUONE-PROGUANIL (ATQ-PG) (Malarone®) (Malarone® Pediatric)
- ARTESUNATE Vial 110 mg powder and vial buffered diluent
- CHLOROQUINE (Novo-Chloroquine) Tablet: 155 mg chloroquine base (250 mg chloroquine diphosphate)
- CLINDAMYCIN (Dalacin C®, Apo-Clindamycin, Novo-Clindamycin, Clindamycine, Clindamycin Injection)
- DOXYCYCLINE (Vibra-Tabs®, Apo-Doxy, Doxycin, Novo-Doxylin, Nu-Doxycycline, ratio-Doxycycline)
- HYDROXYCHLOROQUINE (Plaquenil, Apo-Hydroxyquine, Gen-Hydroxychloroquine) Tablet: 155 mg base
- MEFLOQUINE (Lariam®, Apo-Mefloquine)
- PRIMAQUINE (Primaquine phosphate)
- QUINIDINE GLUCONATE-SULPHATE
- QUININE DIHYDROCHLORIDE
- QUININE SULPHATE (Novo-Quinine®, Apo-Quinine, Quinine-Odan)
Indication | Prevention and treatment of P. falciparum and P. vivax malaria |
---|---|
Adult dosage | Adult tablet: 250 mg atovaquone plus 100 mg proguanil hydrochloride Prevention: 1 tablet daily; start one day before entering malaria-endemic area and continue during exposure and for 7 days after leaving Treatment:1,000 mg atovaquone AND 400 mg proguanil (4 tablets) once daily × 3 days |
Pediatric dosage | Pediatric tablets 62.5 mg atovaquone plus 25 mg proguanil hydrochloride Prevention: >1 tablet daily; start 1 day before entering malarialarea and continue during exposure and for 7 days after leaving;
Treatment: 20 mg/kg atovaquone AND 8 mg/kg proguanil once daily × 3 days;
|
Advantage | Causal prophylaxis - only have to continue for 7 days after exposure |
Disadvantage | Daily dosing for prophylaxis |
Adverse effects | Frequent:
Rare:
|
Indication | Treatment of severe and complicated malaria |
---|---|
Adult dosage | Treatment: 2.4 mg/kg intravenous bolus at hours 0, 12, 24 and 48 with possible doses daily for total of 7 days if concurrent doxycycline, ATQ-PG or clindamycin are not tolerated (see Chapter 7) |
Pediatric dosage | Treatment: 2.4 mg/kg at hours 0, 12, 24 and 48 with possible doses daily for total of 7 days if concurrent doxycycline, ATQ-PG or clindamycin are not tolerated (see Chapter 7) |
Advantage | Faster response than parenteral quinine; no cardiovascular or hypoglycemic effects |
Disadvantage | Requires concurrent therapy with second drug |
Adverse effects | Frequent:
Occasional: Severe allergic reactions (65) |
Indication | Prevention and treatment in chloroquine- sensitive P. falciparum and P. vivax areas Treatment of, P. ovale, P. malariae and P. knowlesi infections |
---|---|
Adult dosage | Prevention: 310 mg base once weekly; start 1 week before entering malaria-endemic area and continue during exposure and for 4 weeks after leaving Treatment: Loading dose of 620 mg base, followed by 310 mg base 6 hours later. This is followed by 310 mg base on each of the next 2 days for a total of 1.55 g base |
Pediatric dosage | Prevention: 5 mg base/kg once weekly; maximum 310 mg base weekly; start 1 week before entering malaria-endemic area and continue during exposure and for 4 weeks after leaving 15-20 kg: ½ tablet >20-25 kg: ¾ tablet >25-35 kg: 1 tablet >35-50 kg: 1½ tablets > 50 kg: 2 tablets Treatment: Total dose of 25 mg base/kg over 3 days: 10 mg base/kg (not to exceed 620 mg base) on days 1 and 2, 5 mg base/kg on day 3 |
Advantage | Long-term safety data for prophylaxis |
Disadvantage | Most areas now report chloroquine resistance |
Adverse effects | Frequent:
Occasional:
Rare:
|
Indication | Alternative treatment for P. falciparum with a second drug if standard therapy contraindicated |
---|---|
Adult dosage | Prevention: no indication Treatment oral: Treatment IV: |
Pediatric dosage | Prevention: no indication Treatment oral: Treatment IV: |
Advantage | Safe in pregnancy and young children |
Disadvantage | Lower efficacy than ATQ-PG alone or combination of doxycycline plus quinine |
Adverse effects | Frequent:
Occasional: Rare:
|
Indication | Prevention of chloroquine-resistant P. falciparum; treatment of chloroquine-resistant P. falciparum when combined with a second drug |
---|---|
Adult dosage | Prevention: 1 tablet (100 mg) once daily; start 1 day before entering malaria-endemic area and continue during exposure and for 4 weeks after leaving Treatment: 1 tablet (100 mg) or 100 mg IV twice daily for 7 days |
Pediatric dosage | Prevention:
Treatment:
|
Advantage | Protection against leptospirosis |
Disadvantage | Daily dosing required for chemoprophylaxis |
Adverse effects | Frequent:
Occasional: Rare:
|
Indication | Prevention and treatment in chloroquine- sensitive P. falciparum and P. vivax areas Treatment of P. ovale, P. malariae and P. knowlesi infections |
---|---|
Adult dosage | Prevention: 310 mg base once weekly; start 1 week before entering malaria-endemic area and continue during exposure and for 4 weeks after leaving Treatment: Loading dose of 620 mg base, followed by 310 mg base 6 hours later. This is followed by 310 mg base on each of the next 2 days for a total of 1.55 g base |
Pediatric dosage | Prevention: 5 mg base/kg once weekly; maximum 310 mg base weekly; start 1 week before entering malaria-endemic area and continue during exposure and for 4 weeks after leaving Treatment: Total dose of 25 mg base/kg over 3 days: 10 mg base/kg (not to exceed 620 mg base) on days 1 and 2, 5 mg base/kg on day 3 |
Advantage | Long-term safety data for prophylaxis |
Disadvantage | Most areas now report chloroquine resistance |
Adverse effects | Frequent:
Occasional:
Rare:
|
Indication | Prevention of P. falciparum |
---|---|
Adult dosage | Prevention: Start at least 1 week (preferably 2–3 weeks) before departure and continue during exposure and for 4 weeks after leaving Loading dose – see text on page 76 (section on mefloquine) 250 mg once weekly Treatment:Not routinely recommended (see Chapter 7) |
Pediatric dosage | Prevention: Start at least 1 week (preferably 2–3 weeks) before departure and continue during exposure and for 4 weeks after leaving Loading dose – see text on page 76 (section on mefloquine) 5 mg/kg once weekly
Treatment: |
Advantage | Weekly dosing Long-term safety data |
Disadvantage | There have been occasional publicized cases of severe intolerance to mefloquine, which may result in increased concern. If mefloquine is the best choice but concern is expressed, consider either a loading dose or start 3 weeks before departure to test for tolerability |
Adverse effects | Frequent:
Occasional:
Rare: |
Indication | Prevention of chloroquine-resistant P. falciparum; terminal prophylaxis for P. vivax andP. ovale (PART); radical cure for P. vivax and P. ovale bloodstream infections |
---|---|
Adult dosage | Prevention: Primary prophylaxis 30 mg base daily. Start 1 day before entering malarial area and continue during exposure and for 7 days after leaving Terminal prophylaxis (PART) or radical cure: |
Pediatric dosage | Prevention: Primary prophylaxis 0.5 mg base/kg daily. Start 1 day before entering malarial area and continue during exposure and for 7 days after leaving Terminal prophylaxis or radical cure: |
Advantage | Causal prophylaxis - only have to continue for 7 days after exposure |
Disadvantage | Daily dosing Require G6PD testing (see Chapter 4) |
Adverse effects | Occasional:
|
|
|
Adult dosage | Prevention: no indication Treatment: |
---|---|
Pediatric dosage | Prevention: no indication Treatment:
|
Disadvantage | Parenteral therapy requires cardiac monitoring |
Adverse effects | Frequent:
Occasional:
Rare: |
Adult dosage | Prevention: no indication Treatment: |
---|---|
Pediatric dosage | Prevention: no indication Treatment: |
Adverse effects | Frequent:
Occasional:
Rare: |
Adult dosage | Prevention: no indication Treatment oral: |
---|---|
Pediatric dosage | Prevention: no indication Treatment oral: |
Adverse effects | Similar to above |
Abbreviations:
- ATQ-PG, atovaquone-proguanil;
- IV, intravenous;
- ART, artemisinin-based combination therapy;
- G6PD, glucose-6-phosphate dehydrogenase;
- GI, gastrointestinal;
- P., Plasmodium;
- po, by mouth;
- q, every;
- QID, 4 times/day;
- SE, southeast;
- TID, 3 times/day.
Page details
- Date modified: