Malaria tablets
Malaria chemoprophylaxis
The three most commonly prescribed medications for malaria chemoprophylaxis are:
Chloroquine could be prescribed in areas with P. vivax only or fully chloroquine sensitive P. falciparum, but since this is only the case in a few places in the world, the use is limited.
Tafenoquine is not licensed in the European Union and therefor is not available in Belgium.
Mechanism of action
Atovaquone-proguanil is directed at the liver phase of the malaria parasite life cycle (causal prophylactic effect). Other chemoprophylactic agents are only directed at the erythrocytic phase (suppressive prophylactic effect). They don’t prevent infection as such, but they have a suppressive prophylactic effect by eradicating the malaria parasites when they infect the red blood cells. This is the reason why medication needs to be taken 28 days after leaving a malaria risk area.
Atovaquone-proguanil has a causal prophylactic effect if started at least 24 hours before entering a malaria endemic area and therefore only needs to be taken until 7 days after leaving a risk area in case of good adherence. However, in case it was not started 24 hours prior to entering an endemic area or daily doses have been skipped while the traveller is potentially exposed to malaria, atovaquone–proguanil prophylaxis should also be taken for 28 days after return.
Summary of malaria chemoprophylaxis
| Doses |
Start from … before entering risk area | Until … after leaving risk | Pregnancy | Breastfeeding | Children | |
| Atovaquone-proguanil: 250mg/100mg | Adults: 1 tablet a day Children >5kg |
1 day | 7 days | If no alternative available |
If child >5kg |
>5kg |
| Doxycycline: 100mg | Adults: 1 tablet a day Children >8y |
1 day | 28 days | 1e trim. | If no alternative available | >8y |
| Mefloquine: 250mg | Adults: 1 tablet a week Children >5kg |
2-3 weeks | 28 days | Yes | Yes | >5kg |
| Chloroquine (Only in areas of little resistance) |
Adults: 300mg base once a week Children: see below | 1 week | 28 days | Yes | Yes | Yes |
Non-pharmaceutical forms of Artemisia
Artemisinin in any form does not work well as prevention against malaria. It has a short elimination half- life, meaning that it only remains in the blood at therapeutic levels for a short time.
The non-pharmaceutical forms of Artemisia, for example in juice extractions, teas, infusion preparations or other herbal remedies for the prevention or treatment of malaria, is not supported by the WHO. The content varies substantially and there is a high risk of delivering subtherapeutic doses, which are insufficient to kill all the parasites and to prevent recrudescence. Medication derived from artemisinin used for malaria treatment is always given in combination with another antimalarial drug to avoid the occurrence of resistance and to prevent recrudescence.
Additional information
- Lariam©: patient warning leaflet Nederlands and Français
- Wikitropica: background information on malaria for medical prefessionals
- Malaria Factsheet (WHO 2022)
- About Malaria (CDC 2022)
- CDC Yellow book: Travel-Related Infectious Diseases - Malaria (CDC 2023)