Aesunate REF: Types of malaria prophylaxis: (A) Primary Prophylaxis: Use of anti-malaria drugs at recommended dosage, staed 2-20 days before depaure to a malarious area and continued for the duration of stay and for 1-4 weeks after return. Causal prophylaxis: This prevents the establishment of infection in the liver by inhibiting the pre-erythrocytic schizogony. Primaquine and proguanil are effective as causal prophylactic drugs. Suppressive prophylaxis: Use of blood schizonticides suppresses the blood forms of the malaria parasite and thus protects against clinical illness. However, P. vivax and P. ovale may cause relapses from the hypnozoites and to prevent this, terminal prophylaxis may be needed. (B) Terminal Prophylaxis: Terminal prophylaxis is the administration of Primaquine for two weeks after returning from travel to tackle the hypnozoites of P. vivax and P. ovale that can cause relapses of malaria. It is indicated only for persons who have had prolonged exposure in malaria-endemic regions, such as expatriates and long-term travellers like missionaries and Peace Corps volunteers. Primaquine is administered after the traveller leaves an endemic area and usually in conjunction with Chloroquine during the last 2 weeks of the 4-week period of prophylaxis after exposure in an endemic area has ended Drugs used in malaria prophylaxis and their doses: Drugs Dosage Pros and Cons Adults Children Atovaquone plus Adult Pediatric tablet of 62.5 Daily dosing; only have to Proguanil(Malarone) tablet of mg atovaquone and 25 mg continue for 7 days after 250 mg proguanil: exposure; not in pregnancy and atovaquone and 100 mg proguanil - 1 tab. daily 5-8 kg: 1/2 tablet daily >8-10 kg: 3/4 tablet daily >10-20 kg: 1 tablet daily >20-30 kg: 2 tablets daily lactation >30-40 kg: 3 tablets daily >40 kg: 1 adult tablet daily Chloroquine 300 mg base 5mg/kg base weekly; Long-term safety known; (Tablet with 150mg base) once weekly maximum 300 mg Chloroquine resistance repoed from most pas of the world; not for persons with epilepsy, psoriasis Proguanil 200 mg daily < 2 yrs: 50 mg/day; Used in combination 2-6 yrs:100 mg/d 7-9 yrs: 150 mg/day; >9 yrs: 200 mg/d Doxycycline(100mg) 100mg once 1.5mg base/kg once daily Daily dosing required; not in daily (max. 100 mg) pregnancy and lactation < 25kg or <8 yr: Not given 25-35kg or 8-10 yr: 50mg 36-50kg or 11-13 yr: 75mg >50kg or >14 yr: 100mg Mefloquine(Tablet with 250 mg base <15 kgs: 5mg of salt/kg; Weekly dosing; occasional repos 250mg base, 274mg salt) once weekly 15-19 kg: % tab/wk; 20-30 kg: 1/2 tab/wk; 31-45 kg: 3/4 tab/wk; >45 kg: 1 tab/wk of severe intolerance; not in first trimester of pregnancy, breast feeding, high altitudes or deep sea diving, patients with epilepsy, psychosis, hea blocks, receiving 13 blockers