NPA Information leaflet

MALARIA PROPHYLAXIS

Expires 30th June 2012

Advice on malaria prophylaxis changes frequently. You will be notified of any changes to this leaflet via the NPA website at www.npa.co.uk. In any case, this information should not be used after June 2012.

Further information on malaria can be found on the Information Database and travel section of the NPA website. An NPA Malaria Prophylaxis resource pack is available from the NPA Sales Department on 01727 800 401 or via the webshop on the NPA website. The pack includes duplicate record sheets allowing a comprehensive record to be kept of the travellers itinerary, medical history and prophylaxis advice given, along with guidance notes, an A4 window poster and a copy of the latest NPA Malaria Prophylaxis leaflet.

SYMPTOMS OF MALARIA

Malignant malaria (Plasmodium falciparum) can develop from seven days after being bitten and the benign form (Plasmodium vivax) may incubate for even longer. The typical symptoms of malaria are fever, sweats, chills, shaking, headache, vomiting, diarrhoea and aching muscles. You should advise customers to seek medical advice if they experience any of these symptoms within one year (in some cases longer), but especially within three months of returning from an endemic area.

No prophylaxis regimen is 100% effective so it is important that you advise your customers to take the following measures to avoid being bitten: Use mosquito nets impregnated with permethrin (an insecticide) around the bed at night. Check that the net has no holes. Tuck the net under the mattress. Use insecticides: mats and plug-in vapourisers are useful in the bedroom; coils for outdoor use. Use effective insect repellents on the skin. DEET (N,N-diethyl-m-toluamide) products are recommended. The Advisory Committee on Malaria Prevention (ACMP) advise that concentrations of DEET below 20% would not be effective against mosquitoes. The protective effects of DEET only last for a few hours so several applications will be necessary; DEET 50% has the longest duration of action. The ACMP also advise that DEET, at a concentration of up to 50%, would be suitable for all individuals (unless allergic) over the age of 2 months including pregnant women (all trimesters) and breast-feeding women. However please check the licence of individual products before a supply is made. For further information please contact the NPA Information Department. As an alternative to DEET products, picaridin in a concentration of 20% (Autan) or lemon eucalyptus extract (Mosiguard) can be used, as these have been shown to be comparable. Wear long sleeved clothing, long trousers and socks when outdoors after sunset. Permethrin products are available for application to clothing. There is no evidence to suggest that taking vitamin B1 (thiamine) will act as a repellent, nor that tea tree or citronella oils are useful as repellents.

ANTI-MOSQUITO MEASURES FOR PREVENTING MALARIA

ADVISING ON MALARIA PROPHYLAXIS

To ensure that correct and consistent advice is given, it is important to ensure that you ask the right questions before advising on malaria prophylaxis.

Where exactly is the client travelling to? Different areas within the same country can have different regimens for

prophylaxis. Is the client planning any day trips or cruises to other areas within the country during their stay? If the client is visiting different areas within the same country how are they travelling between them, for example overland, by plane or by boat? When is the client travelling and how long are they staying? Is it an organised package or an independent trip? Does anyone travelling suffer from any underlying condition that may affect the choice of regimen, for example epilepsy, psoriasis, renal impairment or depressive illness? Are any of the travellers pregnant or breastfeeding? Are any children travelling? If so, what are their ages and weights? Note that childrens doses are unlicensed and will require a prescription from a prescriber. For clients going on a cruise, please contact the NPA Information Department for advice.

National Pharmacy Association Information Department Mallinson House, 38-42 St Peters Street, St Albans, Herts AL1 3NP Tel Fax 01727 891 800 or 0844 7364 201 01727 795 902

Email information@npa.co.uk

Produced by the National Pharmacy Association Information Department December 2011.

www.npa.co.uk

PRECAUTIONS

Doxycycline can rarely cause photosensitivity in patients taking it at doses for malaria prophylaxis, however it is normally mild and can be minimised by using a high factor sunscreen. Doxycycline should be avoided in patients with porphyria and systemic lupus erythematous. Mefloquine should be avoided in patients with hypersensitivity to quinine and in patients with a history of any type of seizures or psychiatric disturbances, including depression, as well as those with a history of cardiac conduction disorders. For travellers planning on SCUBA diving, mefloquine is not considered to be the drug of choice. Chloroquine is contraindicated in patients taking amiodarone, and should be used with caution in epilepsy and porphyria. It can cause flare-ups of psoriasis, and may interact with digoxin.

SPECIAL CONSIDERATIONS

Epilepsy: Chloroquine should be used cautiously in patients with epilepsy and mefloquine is contraindicated (see above). Some anti-epileptics may alter the metabolism of doxycycline and reduce its plasma levels, although there is no evidence to suggest increasing the dose. Please contact the NPA Information Department for advice.

Pregnancy: Travel to malarious zones during pregnancy should be avoided. However, if travel is unavoidable, effective prophylaxis should be used as malaria is more severe during pregnancy and the risk of malaria to mother and foetus is greater than the risk from the antimalarial drug at the recommended dose. You should refer all pregnant travellers to their doctor. Chloroquine and proguanil may be taken in their usual doses throughout pregnancy; pregnant women taking proguanil should be supplemented with 5mg of folic acid daily. Doxycycline is contraindicated during pregnancy. Mefloquine is not licensed for use in pregnancy, but can be considered with caution following expert advice if the clinical benefits are considered to outweigh the risks. Malarone should be avoided because its safety in pregnancy has not been established. Please contact the NPA Information Department for further information. Breast-feeding and breast-fed infants: Prophylaxis is still required in breast-fed infants as although antimalarials are excreted in breast milk, the amounts are too variable to give reliable protection. Doxycycline is contraindicated, and the manufacturers of Malarone do not recommend its use whilst breastfeeding due to lack of data. Mefloquine may be suitable in some circumstances, please contact the NPA Information Department for advice. In addition please contact the NPA Information Department for more specific guidance on the following patient groups: Patients taking anticoagulants Those with glucose 6-phosphate dehydrogenase deficiency (G6PD) Immuno-compromised patients Patients with sickle cell disease Patients who have had a splenectomy, or whose spleen does not function properly.

Hepatic or renal impairment: All patients with hepatic or renal impairment should be referred to their specialist, as you will not know the degree of their condition.

Key to Prophylaxis Regimens

Mef/Dox/ Mal Mefloquine one tablet weekly OR Doxycycline 100mg daily OR Malarone one tablet daily

This chart is not comprehensive please contact the NPA Information Department on 01727 891 800 or 0844 7364 201 for countries not listed and for itineraries of more than one country. (The NPA Information Department is for members only and these telephone numbers must not be given to members of the general public.) Please remember: Patients who are visiting a number of low risk areas within one country and are travelling overland between these areas, may be passing through areas of greater risk and may require prophylaxis. Preferred regimens should always be taken unless there is a medical reason why this is not possible. Alternative regimens may not provide optimal cover; please contact the NPA Information Department for advice. No prophylaxis regimen is 100% effective so it is important that you advise your customers to take adequate measures to avoid being bitten. Mefloquine, doxycycline and Malarone are prescription only medicines and must not be sold for malaria prophylaxis under any circumstances.

Dox or Mal Doxycycline 100mg daily OR Malarone one tablet daily only PC Proguanil two tablets daily PLUS Chloroquine two tablets weekly Chloroquine two tablets weekly (preferred regimen) OR Proguanil two tablets daily No chemoprophylaxis required. Use insect repellents, mosquito nets and wear long sleeved clothing after dusk No risk of malaria. No chemoprophylaxis or bite avoidance measures required

NPA December 2011

Country / Region AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA and BARBUDA ARGENTINA ARMENIA ARUBA ASCENSION ISLAND AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA

Area
Areas below 2000m between May November No risk of malaria Very low risk in the Illizi Department only, avoid mosquito bites No risk of malaria No risk of malaria All areas No risk of malaria No risk of malaria

Prophylaxis
PC x R x x Mef/Dox/Mal x x C R

BORNEO (Indonesian Borneo) BORNEO (Malaysian Borneo) BOSNIA and HERZEGOVINA BOTSWANA BRAZIL

Rural areas along northern border in the Chacos, Corrientes, Jujuy, Misiones and Salta provinces All other areas, including Iguacu Falls very low risk, avoid mosquito bites No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria Southern border areas between May October All areas very low risk, avoid mosquito bites No risk of malaria South eastern areas including Chittagong Hill Tract districts All other areas very low risk, avoid mosquito bites No risk of malaria No risk of malaria No risk of malaria All rural areas, except no risk in Belize district or Belize City All areas No risk of malaria Southern districts only Amazon basin area in the departments of northern Beni, Pando and Santa Cruz Other rural areas below 2500m Kalimantan, all areas Eastern inland areas of Sabah Inland forested areas of Sarawak Coastal areas of Sabah and Sarawak, and Kota Kinabalu - low risk No risk of malaria

x x x x x C R x Mef/Dox/Mal R x x x C Mef/Dox/Mal x PC Mef/Dox/Mal PC PC

BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA

Northern half of the country between November June The Amazon basin region All other areas, including Iguau Falls very low risk, avoid mosquito bites All areas very low risk, avoid mosquito bites No risk of malaria All areas All areas Mefloquine resistance present in western provinces All other areas, except no risk in Phnom Penh All areas No risk of malaria Small risk on the Island of Sao Tiago between August - November No risk of malaria All areas

Mef/Dox/Mal PC R x

Mef/Dox/Mal Mef/Dox/Mal R R

CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA

All areas No risk of malaria (including Easter Island) Yunnan and Hainan provinces (including Hainan Island) Remote rural areas below 1500m Main tourist areas, including Hong Kong and Yangtze cruises very low risk, avoid mosquito bites
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x Mef/Dox/Mal Mef/Dox/Mal Dox or Mal only Mef/Dox/Mal Mef/Dox/Mal x R x Mef/Dox/Mal Mef/Dox/Mal x Mef/Dox/Mal C R

NPA December 2011

Most areas below 1600m COLOMBIA All areas COMOROS All areas CONGO All areas CONGO, DEMOCRATIC REPUBLIC OF (formerly Zaire) No risk of malaria COOK ISLANDS Limon province, except no risk in the city of Limon (Puerto Limon) COSTA RICA All other rural areas below 500m All areas No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria (including Faroe Islands) All areas No risk of malaria All areas All areas Esmeraldas province and the Amazon basin area All other areas below 1500m, except no risk in Galapagos Islands, Guayaquil or Quito El Faiym (Al Fayym) area between June October (this area is EGYPT 50 miles south west of Cairo) All other areas very low risk, avoid mosquito bites Santa Ana, Ahuachapn and La Unin provinces in western El Salvador EL SALVADOR All areas EQUATORIAL GUINEA All areas ERITREA No risk of malaria ESTONIA Areas below 2000m, except no risk in Addis Ababa ETHIOPIA No risk of malaria FALKLAND ISLANDS No risk of malaria FIJI No risk of malaria FINLAND No risk of malaria FRANCE All areas, especially borders FRENCH GUIANA No risk of malaria (including Bora Bora Islands and Tahiti) FRENCH POLYNESIA All areas GABON All areas GAMBIA South eastern villages between July October GEORGIA No risk of malaria GERMANY All areas GHANA No risk of malaria GIBRALTAR No risk of malaria GREECE No risk of malaria GRENADA No risk of malaria GUADELOUPE No risk of malaria GUAM Areas below 1500m GUATEMALA All areas GUINEA All areas GUINEA-BISSAU All interior areas GUYANA Georgetown and coastal areas - low risk, avoid mosquito bites All areas HAITI No risk of malaria HAWAII All areas HONDURAS HONG KONG (see CHINA) All areas - very low risk, avoid mosquito bites No risk of malaria HUNGARY Assam INDIA Low risk in southern states of Karnataka, Kerala, Tamil Nadu; southern Andhra Pradesh (including Hyderabad) Low to no risk in the cities of Delhi and Mumbai (but not the state of Maharashtra, see below) Low to no risk in the northern states of Haryana, Himachal Pradesh, Jammu and Kashmir, Punjab, Rajasthan (including Jaipur), Sikkim, Uttarakhand and Uttar Pradesh (including Agra). However if patients are travelling overland between these areas they may be passing through areas of greater risk and require prophylaxis. Most other areas not listed above including Goa, Gujarat, Maharashtra and the Andaman and Nicobar Islands Lakshadweep Islands

Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal x C R Mef/Dox/Mal x x x x x Mef/Dox/Mal x C Mef/Dox/Mal Mef/Dox/Mal PC C

CTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR (Timor Leste) ECUADOR

Mef/Dox/Mal R

R C Mef/Dox/Mal Mef/Dox/Mal x Mef/Dox/Mal x x x x Mef/Dox/Mal x Mef/Dox/Mal Mef/Dox/Mal R x Mef/Dox/Mal x x x x x C Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal R C x C R x

PC x

NPA December 2011

INDONESIA and JAVA (see also Borneo - Indonesian Borneo) IRAN IRAQ

ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA

KIRIBATI KOREA KOSOVO KUWAIT KYRGYZSTAN

LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACEDONIA MADAGASCAR MALAWI MALAYSIA (see also Borneo Malaysian Borneo) MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO

South eastern rural areas between March November Northern border with Azerbaijan between May October All other areas very low risk, avoid mosquito bites Northern rural areas between May October All other areas No risk of malaria No risk of malaria All areas All areas very low risk, avoid mosquito bites (sporadic cases reported in Kingston) No risk of malaria No risk of malaria No risk of malaria Main urban areas of Nairobi very low risk, avoid mosquito bites All other areas below 2500m No risk of malaria Border area between North and South No risk of malaria No risk of malaria South western areas between May October All other areas very low risk, avoid mosquito bites All areas, except no risk in Vientiane No risk of malaria No risk of malaria No risk of malaria All areas All areas very low risk, avoid mosquito bites No risk of malaria No risk of malaria No risk of malaria No risk of malaria All areas All areas Peninsular Malaysia inland forested areas, including Taman Negara National Park All other areas including Cameron Highlands, Kuala Lumpur and Penang very low risk, avoid mosquito bites No risk of malaria All areas No risk of malaria No risk of malaria No risk of malaria North of the country between July October South of the country all year round All areas very low risk, avoid mosquito bites All areas Southern states of Oaxaca and Chiapas All other areas very low risk, avoid mosquito bites No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria All areas Mefloquine resistance in eastern part of Shan State All other areas Areas along Kavango and Kunene Rivers all year round Northern third of the country between November June No risk of malaria
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Papua (Irian Jaya) and Lombok Rural areas Bali, and cities on the islands of Java and Sumatra

Mef/Dox/Mal PC R

PC C R C R x x Mef/Dox/Mal R x x x R Mef/Dox/Mal x R x x C R Mef/Dox/Mal x x x Mef/Dox/Mal R x x x x Mef/Dox/Mal Mef/Dox/Mal PC R

MICRONESIA MOLDOVA MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR (formerly Burma) NAMIBIA NAURU

x Mef/Dox/Mal Mef/Dox/Mal R Mef/Dox/Mal C R x x x x x x x Mef/Dox/Mal Dox or Mal only Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal x

x Mef/Dox/Mal x x

NPA December 2011

NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA

Areas below 1500m including Terai districts, except no risk in Kathmandu No risk of malaria No risk of malaria (including Saint Martin) No risk of malaria No risk of malaria City of Managau - very low risk, avoid mosquito bites All other areas All areas All areas No risk of malaria No risk of malaria Remote rural areas of Musandam province Areas below 2000m No risk of malaria East of Panama Canal West of Panama Canal Low risk in Panama City and for cruises on Panama Canal All areas below 1800m

PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES

PITCAIRN ISLANDS POLAND PORTUGAL PUERTO RICO QATAR RUNION ISLAND ROMANIA RUSSIA RWANDA SAINT HELENA SAINT KITTS and NEVIS SAINT LUCIA SAINT PIERRE and MIQUELON SAINT VINCENT and the GRENADINES SAMOA SAN MARINO SO TOM and PRNCIPE SARDINIA SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA

Rural areas Amazon basin area Rural areas east of the Andes and west of Amazon basin below 1500m All other areas including the south coast and Lima very low risk, avoid mosquito bites Rural areas below 600m No risk in cities and the islands of Cebu, Bohol and Catanduanes No risk of malaria No risk of malaria No risk of malaria (including Azores and Madeira) No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria All areas No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria No risk of malaria All areas

x x R C Mef/Dox/Mal Mef/Dox/Mal x x PC PC x PC C R Mef/Dox/Mal C Mef/Dox/Mal PC R

PC x x

PC x x x x x x x x x Mef/Dox/Mal x x x x x x x Mef/Dox/Mal x PC x

No risk of malaria South western provinces and rural areas in the west All other areas including Jeddah, Mecca, Medina and high altitude areas of Asir province no risk of malaria All areas No risk of malaria No risk of malaria All areas All areas very low risk, avoid mosquito bites No risk of malaria No risk of malaria All areas All areas Low altitude areas of Limpopo and Mpumalanga including Kruger National Park and KwaZulu-Natal as far south as Jozini All other areas very low risk, avoid mosquito bites
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Mef/Dox/Mal x x Mef/Dox/Mal R x x Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal R

NPA December 2011

SPAIN SRI LANKA

SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA TASMANIA THAILAND

TIBET TOGO TOKELAU TONGA TRINIDAD and TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS and CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES URUGUAY USA UZBEKISTAN VANUATU VENEZUELA VIET NAM

No risk of malaria (including Balearic and Canary Islands) North of, and including, Vavuniya All other areas, including Colombo and Kandy All areas All areas, except no risk in the city of Paramaribo or coastal areas All areas No risk of malaria No risk of malaria Northern border between May October No risk of malaria All areas between June October (especially the southern border) All areas (including Pemba and Zanzibar) No risk of malaria Near borders with Myanmar (Burma), Cambodia and Laos mefloquine resistance present All other areas including Chiang Mai, Chiang Rai, Ko Chang and Ko Samui Islands, Kwai bridge, Pattaya and Phuket very low risk, avoid mosquito bites No risk in Bangkok No risk of malaria All areas No risk of malaria No risk of malaria No risk of malaria No risk of malaria Border with Syria, plain around and east of Adana between March November All other areas very low risk, avoid mosquito bites No risk of malaria No risk of malaria

x PC R Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal x x C x PC Mef/Dox/Mal x Dox or Mal only R

x x Mef/Dox/Mal x x x x C R x x

VIRGIN ISLANDS (British and American) WAKE ISLANDS WALLIS and FUTUNA ISLANDS YEMEN ZAMBIA ZIMBABWE

No risk of malaria All areas No risk of malaria No risk in any area, including Abu Dhabi, Ajman, Dubai, Sharjah, and Umm al-Qaiwain No risk of malaria No risk of malaria Sporadic cases in south eastern areas very low risk, avoid mosquito bites All areas Amazon basin area, Angel Falls and areas south of and including Orinoco River Rural areas north of Orinoco River No risk in Caracas or Margarita Island Cities, Mekong River until close to the Cambodian border and the coastal areas, from Hanoi down to Ho Chi Minh Rural areas in the southern part of the country in the provinces of Dac Lac, Gia Lai, Kon Tum, Lam Dong and Tay Ninh - mefloquine resistance present All other areas No risk of malaria (including Tortola) No risk of malaria No risk of malaria

x Mef/Dox/Mal x x x x R Mef/Dox/Mal Mef/Dox/Mal PC x R

Dox or Mal only Mef/Dox/Mal x x x

All areas, except no risk in Sanaa city All areas Zambezi valley and Victoria Falls all year round All other areas below 1200m between November June Harare and Bulawayo very low risk, avoid mosquito bites

PC Mef/Dox/Mal Mef/Dox/Mal Mef/Dox/Mal R

Please remember: No prophylaxis regimen is 100% effective so it is important that you advise your customers to take adequate measures to avoid being bitten.
7 NPA December 2011

DOSAGE SCHEDULE Antimalarial drugs should be taken with food and swallowed with plenty of water. Clients should be counselled on the importance of completing the course on return from the endemic area. Antimalarial Mefloquine Schedule 250mg weekly: 1 x 250mg Lariam tablet. Take two to three weeks before travel, throughout stay and for four weeks after return. 100mg daily: 1 x 100mg Doxycycline tablet/capsule. Take one to two days before travel, throughout stay and for four weeks after return. 1 (250mg/100mg) Malarone tablet daily: Take one to two days before travel, throughout stay and for seven days after return. 300mg base weekly: 2 x 250mg Avloclor tablets (155mg base per tablet). Take one week before travel, throughout stay and for four weeks after return.
(Nivaquine 200mg (150mg base) is now discontinued).

Long term travel Currently licensed to be used for a period of twelve months; however can be taken safely for up to three years.

Doxycycline

Can be taken for up to two years.

Malarone (atovaquone/ proguanil) Chloroquine

Currently licensed for periods of stay not exceeding twenty-eight days; however there is now experience of it being taken safely for up to one year. Can be taken continuously for up to six years; beyond this, regular ophthalmic examinations are recommended.

Proguanil

200mg daily: 2 x 100mg Paludrine tablets. Take one week before travel, throughout stay and for four weeks after return.

No time limit specified.

CHILDRENS DOSAGES Calculate the dose by weight rather than by age in infants and children. The following doses are based on guidelines from the ACMP for UK travellers and may differ from advice in PILs/SPCs (unlicensed doses should not be sold, but must be prescribed on prescription). Contact the NPA Information Department for further advice. NB: Paediatric doses of Malarone and chloroquine syrup are given separately towards the bottom of the page.
Age Term 12 weeks 12 weeks 11 months 1 year 3 years 11 months Weight Under 6kg 6 9.9kg 10 15.9kg Chloroquine (base) once weekly 37.5mg (14 tablet) 75mg (12 tablet) 112.5mg (34 tablet) 150mg (1 tablet) Proguanil once daily 25mg (14 tablet) 50mg (12 tablet) 75mg (34 tablet) 100mg (1 tablet) Mefloquine once weekly * 62.5mg (14 tablet) 62.5mg (14tablet) 125mg (12 tablet) Doxycycline once daily
Adult dose from 12yrs 100mg (1 tab/cap)

4 years 7 years 11 months 16 24.9kg 8 years 12 years 11 months 25 44.9kg 13 years and over 45kg and over

225mg (112 tablets) 150mg (112 tablets) 187.5mg (34 tablet) 300mg (2 tablets) 200mg (2 tablets) 250mg (1 tablet)

100mg (1 tab/cap)

Malarone once daily

Weight

11 20.9kg 1 Malarone paediatric tablet

21 30.9kg 2 Malarone paediatric tablets as a single dose

31 40kg 3 Malarone paediatric tablets as a single dose

Over 40kg Adult dose

Chloroquine syrup Age Weight

Under 6 weeks 6 weeks 5 months 6 12 months 13 months 2yrs 11 months 3yrs to 3yrs 11 months Under 4.5kg 4.5 7.9kg 8 10.9kg 11 14.9kg 15 16.5kg 2.5ml 5.0ml 7.5ml 10ml 12.5ml

weekly dose

(Chloroquine base 50mg/5ml) NB: These dose steps are not the same for chloroquine tablets, which differ from the syrup in chloroquine content * Mefloquine (1/4 tablet) may be advised for children weighing 5 - 9.9kg

National Pharmacy Association Information Department Mallinson House, 38-42 St Peters Street, St Albans, Herts AL1 3NP
NPA December 2011

Tel Fax

01727 891 800 or 0844 7364 201 01727 795 902

Email information@npa.co.uk

www.npa.co.uk
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