Malaria Prophylaxis

Malaria is an infectious disease that occurs primarily in tropical and subtropical regions. Africa is the most commonly affected, with more than 90% of cases. It is estimated that up to 500,000,000 people worldwide fall ill every year. More than two million people die of malaria every year. The infected persons reported in Germany are mainly infected in Africa, less frequently in India or Papua New Guinea (imported cases).

Before traveling to a malaria endemic area (especially Africa, areas in Oceania and South America), a consultation with a physician experienced in travel medicine should be made. There is no vaccination against malaria.

The following groups of people should take malaria prophylaxis:

  • Travelers who want to visit malaria endemic areas.

Agents

Active ingredients Dosage Duration Special features
Atovaquone/Proguanil 250/100 mg/d (adults) 62.5/25 mg/d (11-20 kg bw) 125/50 mg (21-30 kg bw) 187.5/75 mg (31-40 kg bw)
  • 1-2 d before travel
  • Until 7 d after end
 Contraindication (contraindication) in severe renal insufficiency (renal impairment/chronic renal failure) In severe hepatic insufficiency (insufficient functioning of the liver) No data.
Proguanil 200 mg/d 3 mg/kg bw/d (children) In combination with chloroquine* .
Chloroquine 300 mg/week 450 mg/week (> 75 kg bw) 5 mg/kg bw/week (children)
  • 1 week before travel
  • Until 4 weeks after end
 Dose adjustment in renal/liver failure.
Chloroquine/proguanil s.o.
  • 1 week before departure
  • Until 4 weeks after end
 Can no longer be recommended Rare use in pregnant women, children < 5 kg bw.
Doxycycline 100 mg/d 1.5-2 mg/kg bw/d (children > 8 years)
  • 1-2 d before travel
  • Until 4 weeks after end
 Contraindication in severe liver dysfunction Not suitable for use alone For malaria prophylaxis not approved in Germany
Mefloquine 250 mg/week 5 mg/kg bw/week (children > 5 kg bw).
  • 1-3 weeks before travel
  • Until 4 weeks after end
 Dose adjustment for hepatic insufficiency.
Primaquine 30 mg/d 0.5 mg/kg bw/d (children)
  • 1 d before travel
  • Until 1 week after end

* For special groups of people such as pregnant women, children, foreign workers, individual travelers, travelers with pre-existing conditions, interactions with antimalarial drugs.

The exact form of chemoprophylaxis is decided by destination, duration of travel, and travel style.

For pregnant women, a careful risk-benefit assessment should be made.

In addition to chemoprophylaxis, the following rules should be followed (exposure prophylaxis):

  • Stay in mosquito-proof rooms (air conditioning, fly screens) during twilight/night.
  • Sleeping under mosquito nets (impregnated with insecticidal substances).
  • Wearing appropriate (if necessary impregnated) clothing (long-sleeved blouses and shirts, long pants, socks).
  • Use of repellents (relative protection!)