Which medicine or medicines would be considered the most suitable -
most effective with least side effects - to take for the prevention of
malaria for someone visiting Uganda in East Africa for a two week
holiday. Is the new drug malarone safe to take?  Is it safe to give to
a 5 year old?

Malarone seems to be a very good choice for prophylaxis of malaria.
All sources I found say itīs an effective and safe agent for the
prophylaxis of malaria. The only minor disadvantage seems to be the
price.

“Malarone TM. This is a combination of atovaquone and proguanil and
recent studies have found it a safe and effective prophylactic agent
with few side affects. Unfortunately it is expensive (~US$42 for 12
tablets) and has to be taken daily. It is not suitable for those
sensitive to atovaquone or proguanil . Treatment should be started 2
days before travel and continued for 7 days after the travel period.”
from:
Malaria Prophylaxis
( http://www.rph.wa.gov.au/labs/haem/malaria/prophylaxis.html  )

“Malarone appears to be extremely well tolerated with fewer side
effects than other available medications. Side effects may include GI
upset or headache. This contrasts with neuro-psychiatic side-effects
of mefloquine and GI upset and sun sensitivity with doxycycline.
Malarone has been available in Denmark since 1998 and was approved for
use in the United States in August, 2000. The drug combination has
been used in Denmark for the past year with an excellent safety
record. Malarone is not licensed for pregnant women or nursing
mothers.”
from:
MCW Health Link
( http://healthlink.mcw.edu/article/979237802.html  )

“Treatment
Malarone has been shown to be highly efficacious in the treatment of
uncomplicated malaria caused by Plasmodium falciparum, including
malaria that has been acquired in areas with chloroquine-resistant or
multidrug-resistant strains.”

It seems to be safe for adults and kids:

“Malarone is available in adult (250 milligram [mg] atovaquone and 100
mg proguanil hydrochloride per tablet) and pediatric (62.5 mg
atovaquone and 25 mg proguanil hydrochloride per tablet) strength
forms. The daily dose should be taken at the same time each day with
food or milk.”

Especially Uganda is listed as a country where Malarone can and should
be used:
“ Malarone is the drug of choice for presumptive self-treatment for
travelers to areas with SP-resistant malaria, including the following
areas:
Amazon Basin of South America 
Southeast Asia 
Some countries in eastern and southern Africa: specifically, Kenya,
Malawi, Mozambique, South Africa, Tanzania, and Uganda.”

There seem to be some adverse reactions: “The most common adverse
effects reported in people using Malarone for prophylaxis or treatment
were abdominal pain, nausea, vomiting, and headache.”, but I could not
find data about the frequency.

“For further questions related to the use of Malarone, CDC may be
contacted (Malaria Hotline: 888-232-3228).”

all from:
CDC Malarone for Malaria Treatment and Prophylaxis
( http://www.cdc.gov/travel/diseases/malaria/malarone.htm )

However - as mentioned before - Malarone is rather expensive:
“ The cost of Malarone is more expensive than other commonly used
medications for malaria prophylaxis. Doxycycline costs pennies per
day. Lariam (mefloquine) and Malarone are considerably more expensive;
coverage for a two week trip using Malarone daily or Larium weekly may
cost between $75 and $100. Malarone becomes more expensive than Larium
after two weeks because it requires a daily pill whereas Larium is
taken weekly. The price per pill decreases as more pills are purchased
and pharmacies have considerable variance in pricing.”
from:
MCW Health Link
( http://healthlink.mcw.edu/article/979237802.html )


Youīll find a comparison of the different drugs used at:
Drugs most commonly used for Malaria Prevention 
( http://geo.ya.com/travelimages/health-malaria-drugs.html )

Search Strategy
( ://www.google.de/search?sourceid=navclient&hl=de&querytime=MVNBR&q=malaria+prophylaxis+malarone
)


till-ga

This was an adequate response.   You gave me the tools to work with. 
I didn't think you  answered the question for me. I felt that you made
up your mind early on that Malarone was the answer.  This gave you a
blinkered approach to the topic.
When I started checking the websites, one of them specifically
mentions that Malarone is not to be given to children.

So Malarone was not the answer for my 5 year old!.

But you did put me on the right path.

As Malarone has been recommended, let me quickly point out that the
efficacy of this drug may be limited if certain other drugs are taken
at the same time. This includes Tetracyclines (certain type of
antibiotics, e.g. Doxycycline), Metoclopramide (given against nausea,
often prescribed to patients suffering from migraine), Rifampicine
(prescribed in tuberculosis) and Rifabutine (tuberculosis, AIDS). Drug
interactions are something that is often forgotten about,
unfortunately.

The following table shows the treatment doses for kids:
(Sorry for the poor formatting. We canīt use formatting options here)

"Table 1. Pediatric Treatment Doses of Malarone™ Body
Weight*(pounds) BodyWeight*(kilograms) Atovaquone/Proguanil HCl
Total Daily Dose Dosage Regimen 
24–45 11–20 250 mg/100 mg 1 adult tablet daily for 3
consecutive days 
46–67 21–30 500 mg/200 mg 2 adult tablets (as a single
dose) daily for 3consecutive days "
from:
CDC Malarone for Malaria ..
( http://www.cdc.gov/travel/diseases/malaria/malarone.htm )

Usually a kid of 5 years should weigh about 19 Kilograms. So I canīt
understand why Malarone should not be suitable for your son.

till-ga

There is really nothing wrong with giving Malarone to Kids. There is
even a special formulation for children - Malarone Pediatric:

http://www.accessdata.fda.gov/scripts/cder/ob/docs/temptndet.cfm?Appl_No=021078&TABLE1=Rx

Malarone has FDA approval for Children from 11 kg. Your 5 year old
should already weigh more than that. For children weighing less than
11 kg, there simply is no study data available yet, which is why it is
not recommended. As to the comment you made how Malarone was not to be
given to children: one website does mention this, but refers to the UK
and only states, that the drug is only LICENSED there from 40 kg of
body weight. The same is true for Germany right now, but I found
reference that from the end of 2002, it will be approved to be used
for smaller children there as well. It really seems to merely be a
license problem.

http://www.pharmazeutische-zeitung.de/pza/2002-17/pharm5.htm