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Malarone x Doxiciclina x Mefloquina

Enviado por roberta goldfarb em 28/01/2010 às 05:36 PM

Definitivamente o Malarone é o melhor.

Atovaquone / Proguanil (Malarone)

Atovaquone/proguanil is a fixed combination of the two drugs, atovaquone and proguanil.

Prophylaxis should begin 1–2 days before travel to malarious areas and should be taken daily, at the same time each day, while in the malarious areas, and daily for 7 days after leaving the area (see Table 2-23 for recommended dosages).

Malarone is very well tolerated, and side effects are rare. The most common adverse effects reported in persons using atovaquone/proguanil for prophylaxis or treatment are abdominal pain, nausea, vomiting, and headache. Malarone should not be used for prophylaxis in children weighing <5 kg, pregnant women, or patients with severe renal impairment (creatinine clearance <30 mL/min). It should be used with caution by patients taking coumadin (warfarin) for anticoagulation.

Doxycycline (Many Brand Names and Generic)

Doxycycline prophylaxis should begin 1–2 days before travel to malarious areas. It should be continued once a day, at the same time each day, during travel in malarious areas and daily for 4 weeks after the traveler leaves such areas.

Insufficient data exist on the antimalarial prophylactic efficacy of related compounds such as minocycline (commonly prescribed for the treatment of acne). Persons on a long-term regimen of minocycline who are in need of malaria prophylaxis should stop taking minocycline 1–2 days before travel and start doxycycline instead. The minocycline can be restarted after the full course of doxycycline is completed (see Table 2-23 for recommended dosages).

Doxycycline can cause photosensitivity, usually manifested as an exaggerated sunburn reaction. The risk for such a reaction can be minimized by avoiding prolonged, direct exposure to the sun and by using sunscreens. In addition, doxycycline use is associated with an increased frequency of vaginal yeast infections. Gastrointestinal side effects (nausea or vomiting) may be minimized by taking the drug with a meal. To reduce the risk for esophagitis, travelers should be advised not to take doxycycline before going to bed. Doxycycline is contraindicated in persons with an allergy to tetracyclines, during pregnancy, and in infants and children <8 years of age.

Vaccination with the oral typhoid vaccine Ty21a should be delayed for at least 24 hours after taking a dose of doxycycline.


Mefloquine prophylaxis should begin 1–2 weeks before travel to malarious areas. It should be continued once a week, on the same day of the week, during travel in malarious areas and for 4 weeks after a traveler leaves such areas (see Table 2-23 for recommended dosages).

Mefloquine has been associated with rare serious adverse reactions (e.g., psychoses, seizures) at prophylactic doses; these reactions are more frequent with the higher doses used for treatment. Other side effects that have occurred in chemoprophylaxis studies include gastrointestinal disturbance, headache, insomnia, abnormal dreams, visual disturbances, depression, anxiety disorder, and dizziness. Other more severe neuropsychiatric disorders occasionally reported during postmarketing surveillance include sensory and motor neuropathies (including paresthesia, tremor, and ataxia), agitation or restlessness, mood changes, panic attacks, forgetfulness, confusion, hallucinations, aggression, paranoia, and encephalopathy. On occasion, psychiatric symptoms have been reported to continue long after mefloquine has been stopped. Mefloquine is contraindicated for use by travelers with a known hypersensitivity to mefloquine or related compounds (e.g., quinine, quinidine) and in persons with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures. It should be used with caution in persons with psychiatric disturbances or a previous history of depression. A review of available data suggests that mefloquine may be used in persons concurrently on beta blockers, if they have no underlying arrhythmia. However, mefloquine is not recommended for persons with cardiac conduction abnormalities.

Any traveler receiving a prescription for mefloquine must also receive a copy of the FDA Medication Guide, which can be found at the following

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