Malarone Dosage (Punta Cana)

Dr. Parks,

Thank you very much for the informative response.  That was a question I had for my pediatrician as well (will the Hep A vaccine be useful if we're only giving it to her a few days before we leave) and she told me "yes".  As per what you explained it won't be effective for 3-6 weeks.  Am I correct then in understanding that it will at least lessen the symptoms of HAV if she contracts it?

After receiving the mefloquine prescription it just wasn't settling well that we had to give this strong medication to our 20 month old for 6 weeks when we were only going away for 1 week.  In researching there were 3 more drugs just as effective in the prevention of malaria yet I ruled out 2 due to the side effects.  When I presented this to my pediatrician she agreed with ruling out 1 of them (doxycycline) and had never heard of the other (Malarone).  She said that they had called the CDC and they had recommended Mefloquine.  Still not satisfied I called myself.  I spoke to a Dr. who was surprised they prescribed Mefloquine for a vacation planned for one week (I didn't even mention my concerns!) and she wasn't so sure if they had called because she said they would have prescribed Malarone.  She mentioned it was safe for use for children over 11 lbs.  She also mentioned that she has used it with her toddler and highly recommended it.  She explained it would be pricy but we don't care about that in comparison to our daughters well being.  This Doctor was awesome.  The problem is that I researched on Drugs.com and it indicated that Malarone wasn't approved or recommended to prevent malaria in children under 25 lbs (my daughter is 22 lbs)!  I tried to call her back but they were closed.  Ughhhh. So my question to you after this long winded question (sorry) is do you have information I might not be able to obtain that may be more detailed to indicate if it would still be safe for her being that there is only a 3 lb. difference?  HELP.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello again.

In answer to your questions and concerns:

1. It is possible that your daughter may develop partial immunity to hepatitis A if she were to be exposed to the virus. This partial immunity could conceivably result in decreased symptoms. The amount of partial immunity is difficult to quantify.

2. With regard to malaria prophylaxis, this is a challenging question that in the end

Your two options besides mefloquine are malarone and chloroquine:

Malarone is approved for malaria prophylaxis in children who weigh 11 kilograms or more (24.2 lbs). Your daughter weighs 10 kilograms. The use of malarone in your daughter is not likely to cause significant increased risk but you should discuss this with a pediatrician or have your pediatrician discuss this with a pediatric infectious disease physician.

For children 11-20 kg
Malarone Dosing: 62.5 mg/25 mg PO qd; Start: 1-2 days prior to arrival in a malarious area and continue through 7 days after return; Info: repeat dose if vomiting occurs within 1h; give w/ food or milk

Chloroquine is also approved for pediatric use and the malaria in DR is sensitive to Chloroquine.
5 mg base/kg by mouth one a week
Start: 1-2 weeks prior to exposure or 5 mg base/kg PO q6h x2 if started after arrival in a malarious area; Max: 300 mg base/dose; Info: continue for 4 weeks after exposure; give w/ food; 500 mg phosphate = 300 mg base

I hope that this is helpful to you.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.