Malaria Selective Chemoprophylaxis

The appropriate regimen for an individual depends on the circumstances.

Risk Groups

The following high-risk groups should be given antimalarial chemoprophylaxis:

Patients with immunosuppression caused by illness (e.g. Leukaemia, but not HIV infection or malnutrition) or splenectomy
Tropical splenomegaly syndrome
Under 5s with recurrent febrile convulsions
Individuals with sickle cell disease
Non-immune visitors (i.e. visitors from non-malarial countries)
Pregnant women

ANTIMALARIAL PROPHYLAXIS REGIMENS

Give Mefloquine (Lariam) 250 mg weekly
- Contraindicated in pilots, people with history of cardiac disease, neurological disease or depression, and in those taking beta-blocking drugs
Give Atovaquone-proguanil ('Malarone') - one tablet daily
- Take for only one week after exposure end
Give Chloroquine 300 mg - 2 tablets weekly. Should be combined with daily proguanil (see below)
- Chloroquine causes itching in 40% of black people. Contraindicated in persons with psoriasis or epilepsy
- Risk of retinal damage if taken every week for more than 6 years - advise a change
Give Proguanil (Paludrine®) 200 mg daily
- Should combine with an additional drug such as weekly Chloroquine

INTERMITTENT PRESUMPTIVE TREATMENT OF MALARIA IN PREGNANCY (IPTP)

Intermittent Presumptive Treatment of malaria in pregnancy (IPTp) is one of the major malaria preventive strategies in Malawi
Pregnant women should receive at least three doses of Sulfadoxine-Pyrimethamine (SP) 525mg after the first trimester
Administer three tablets of SP with each scheduled antenatal care visit after 1st trimester (at 13 weeks’ gestation)
The doses should be administered at least four weeks apart and given as directly observed therapy (DOT)
The last dose of SP can be delivered safely up until the time of delivery
Sulfadoxine-Pyrimethamine can be given either on an empty stomach or with food

Note: HIV positive women receiving Cotrimoxazole Prophylaxis should not receive SP