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(3) take “the pill”
(3) Proguanil (Paludrine®):
There are several dangerous myths regarding Chloroquine (Nivaquine® or Daramal® or • Prophylaxis does not make the diagnosis • Dosage: Two tablets every day starting one • It does protect against the development of week prior to exposure until four weeks after. • Contra-indications: Known allergy to • Prophylaxis is not 100% effective - hence the Proguanil. Interactions with Warfarin (An anti-coagulant/blood thinning agent that is • Not all anti-malaria medication is safe with • Side effects: Heartburn (Tip: take after a • Malaria is often fatal – making prophylaxis meal, with a glass of water and do not lie down shortly after taking Proguanil); mouth Anti-malaria drugs, like all drugs, have potential ulcers (Tip: take folic acid tablets, 5 mg per side effects. The majority of side effects day, if this occurs); loose stools (self limiting decrease with time. Serious side effects are rare and can be avoided by careful selection • Use in pregnancy: Safe, but must be taken of a tablet or combination of tablets to suit your with a folic acid supplement: 5 mg per day. requirements (country, region and season). (Note: scuba diving is not considered safe The following drugs are available for the The combination of Chloroquine and Proguanil (1) Doxycycline (Vibramycin® or
is about 65% effective for resistant falciparum Cyclidox® or Doryx®, etc.):
malaria. Although not a first choice, its relative “ Doxycycline
• Used extensively in the prevention of safety and limited side effects may justify its use chloroquine resistant malaria. About 99% effective. Not officially recommended for (4) Atovaquone/Proguanil (Malarone ®;
use in excess of eight weeks for malaria Malanil ®):
prevention, but it has been used for as long • Registered in South Africa as a causal prophylaxis in February 2004. Safety in diving have used it with no adverse effects. Use • Dosage: 100 mg daily after a meal starting with caution. Additional sensitivity to motion one - two days before exposure until four weeks after exposure. Doxycycline should Preliminary data suggests it is safe for pilots. be taken with plenty of non-alcoholic liquid. • Effective against malaria isolates that are breasfeeding, children < eight years. • Controlled studies have shown a 98% overall • Side effects: Nausea, vomiting, diarrhoea, prevention of P. falciparum malaria.
vaginal thrush and may reduce the efficacy • Dosage: One tablet daily for adults, starting 24 - 48 hours prior to arrival in endemic • Use in pregnancy: Unsafe (as is scuba area, during exposure in endemic area and for seven days after leaving the endemic Doxycycline is DAN-SA’s agent of choice time each day with food or a milky drink. (2) Chloroquine (Nivaquine® or Daramal®
impairment (i.e. significant renal disease or Plasmaquine®):
is likely to be incompatible with diving). • Contains only chloroquine. Must be taken in Safety in children < 11 kg has not been combination with Proguanil (Paludrine®). • Dosage: Two tablets weekly starting one • Side effects: Heartburn (Tip: take after week before exposure until four weeks after lie down shortly after taking Atovaquone/ • Contra-indications: Known allergy, epilepsy.
photosensitivity (sunburn; prevention – apply • Use in pregnancy: Safety in pregnancy and • Use in pregnancy: Safe. (Note: scuba diving lactating women has not been established. is not considered safe during pregnancy.) (Note: scuba diving is not considered safe during pregnancy.) Autumn 2009 ALERTDiver 37

Source: http://www.dansa.org/downloads/autumm2009/print/page39.pdf