Long Term Malaria Prophylaxis
I seem to be hearing this question a lot, lately. I will try to give a brief summary of what I know…
Basically, there is not a lot of good literature on long term use of atovaquone/proguanil (Malarone). This seems to be an area that needs some more research. Most of the data that is being discussed, currently, centers around a short study of UN Peacekeepers who took the drug combo for approx 6 months with no severe reactions noted. It is a small study with only a few hundred patients, if memory serves. Nothing solid. The two drugs in the compound are both, individually, well studied and safe for long term use. Proguanil is not suitable for solo-protection as drug resistance is common. Oh, I got a good bit of info about malarone and it’s efficacy being increased when taken with a fatty meal versus an empty stomach. This appears to be true, as the fat in the meal helps it absorb. The EU has set a limit of use that ranges from 5 weeks to 3 months, depending on the country. The USA does not have any restriction on its use, with respect to time.
Well studied and commonly used, often for long term use. The main thing to know is “Will this protect me?” This is only a drug to be used in geographic areas with known sensitivity to chloroquine. There is a link between long term chloroquine use and retinopathy (eye problems). Literature disagrees on how many YEARS that is, but a commonly accepted value is 5 years of 300 miligrams per week or 3 years if taking 100 miligrams per day. Most all people I see and talk with get advised to have a regular eye exam (every 6 months) after 2-3 years of any dose of chloroquine.
There is a lot of study on the long term use of this medication and it seems to be safe for long term use. If you can tolerate the mefloquine for the first 3-4 weeks, you should be fine for several years of use.
Again, if you can tolerate the side effects of the medication (sun sensitivity, risk of vaginal yeast infections, GI/diarrhea and dietary restrictions), this medication seems safe for long term use, greater than 6 months. Most of the studies do not show any data of use longer than six months.
This information is from a collection of resources including:
Travel and Tropical Medicine Manual
Author: Jong and McMullen
Pretty good journal link about long term malaria protection (technical)
Malaria Prophylaxis for Long-Term Travelers
This is a PDF from Communicable Disease and Public Health
Many, many issues of The Journal of Travel Medicine and too many years of higher education.
If there are any other opinions or sources out there that have some good data, please send them to me…I am always trying to learn more!