Chimioprophylaxie du paludisme chez l'enfant

Abstract

Chemoprophylaxis is essential for malaria prevention in travelers. When malaria is susceptible to chloroquine, this drug (Nivaquine^®) has to be used. In France, chloroquine is given daily (1.5 mg/kg/d), from departure to 4 weeks after return. In case of low chloroquine-resistance, French authorities recommend the use of chloroquine + proguanil (Savarine^® if the body weight is > 50 kg or Nivaquine^® + Paludrine^® if < 50 kg), or atovaquone + proguanil (Malarone^®). Nivaquine^® (1.5 mg / kg / d) and Paludrine^® (3 mg/kg/d) must be taken for up to one month after return, although Malarone^® (1 pediatric tablet/10 kg/d, in children > 10 kg weight) may be disrupted after one single week. Adverse events are more rare with atovaquone + proguanil, than with chloroquine + proguanil. When chloroquine-resistance is high, Malarone^® or mefloquine (Lariam^®) are used. Weekly drug regimen is recommended with mefloquine (5 mg/kg/w) for the travel duration and 3 weeks after return; drug tolerance is good in pediatric prophylaxis. The use of doxycycline is limited to some specific conditions of risk, in children of > 8 years of age. New agents such as tafenoquine, an amino-8 quinoleine, might enhance patient's compliance if given monthly.