Table 1. Chemoprophylactic regimens against Plasmodium vivax infection.
| Indication and treatment | Contraindicationsa | Dose | When to start | Treatment duration |
|---|---|---|---|---|
| Suppressive chemoprophylaxis in pregnancy | ||||
| Chloroquine | Severe renal or hepatic disease, can exacerbate psoriasisa | 300 mg base weekly | First antenatal visit or 3 weeks after treatment of vivax malaria | Continue until delivery |
| Suppressive chemoprophylaxis in travellers | ||||
| Any antimalarial regimen that is used for P. falciparum chemoprophylaxis (doxycycline or mefloquine) | Doxycycline: Myasthenia gravis, children <8 years, second or third trimester pregnancy Mefloquine: Epilepsy, history of or current psychiatric disease, severe hepatic disease |
Doxycycline 100 mg daily Mefloquine 250 mg base weekly |
1 day before travel 4 weeks before travel |
Continue for 4 weeks after return to nonendemic area |
| Causal prophylaxis in travellers | ||||
| Primaquine | G6PD deficiency, pregnancy, mothers breast feeding infants (<6 months)b or those who are G6PD deficient, and infants <6 months | 30 mg base daily with food | 1 day before travel | Continue until 7 days after return to nonendemic area |
| Tafenoquinec,d | G6PD deficiency (quantitative testing showing >70% normal activity required), pregnancy, mothers breast feeding infants who are G6PD deficient, history of psychotic disorder or current psychiatric symptoms | Loading dose of 200 mg base daily for 3 days, then 200 mg weekly with food (maximum 6 months) | 1 day before travel | |
| Atovaquone-proguanil | Pregnancy, severe renal disease (GFR <30 mL/min) | 250 mg/100 mg (1 tablet) daily with food | 1 day before travel | |
| Presumptive antirelapse therapy in travellers (PART)–necessary after suppressive chemoprophylaxis | ||||
| Primaquine | Same as for the causal prophylaxis indication | 0.25–0.50 mg base/kg/day with food | 7 days after return to the nonendemic area | 14 days |
| Tafenoquined (currently recommended only in combination with chloroquine treatment or chemoprophylaxis)c | Same as for the causal prophylaxis indication, except that history of psychiatric disorder or current psychiatric symptoms are not a contraindication | 300 mg base with food | 7 days after return to the nonendemic area | Single dose |
a Contraindications listed are in addition to allergy and apply only to the prophylaxis and not treatment indication.
b Minimal primaquine was excreted into mature breast milk in a study of breast feeding infants >28 days old [57].
c Tafenoquine product labelling has been changed so that only chloroquine may be used as the partner schizonticide [58,59]. Paediatric dosing recommendations are anticipated (TEACH trial) [60].
d The US Centers for Disease Control and Prevention (CDC) malaria guidance extends the use of tafenoquine for radical cure to PART [61].
GFR, glomerular filtration rate; G6PDd, glucose-6-phosphate dehydrogenase deficiency; PART, presumptive antirelapse therapy.