A Narrative Review of Use of Drugs for Prevention of Malaria

Abstract

An estimated 3.4 billion people are at risk of malaria. The use of drugs for prevention of malaria among people at risk of the disease has been practiced since centuries in the form of chemoprophylaxis, intermittent preventive treatment (IPT) or Mass Drug Administration (MDA). Articles were retrieved using search from Cochrane database of Systematic reviews and Google search. Keywords used included "malaria chemoprophylaxis"," Drugs for prevention of Malaria" and "guidelines for prevention of Malaria". Chemoprophylaxis is an effective strategy for a limited time but it does not offer lifelong protection. The 6 drugs in the WHO guidelines for chemoprophylaxis of Malaria are Atovaquine Proguanil combination, Chloroquine, Chloroquine- Proguanil combination, Doxycycline, Mefloquine and Proguanil. The guidelines for India recommend Doxycycline for short stay and Mefloquine for longer stay. Regimens recommended for use in South Africa include Mefloquine, Doxycycline or Atovaquone-proguanil. Though MDA has gone into disrepute because of its ability to produce drug resistance, examples of successful elimination using MDA exist. IPT given to women in first and second pregnancies reduced the number of women with severe anaemia, perinatal deaths and increased the birth weight of babies. WHO recommended IPT for children consists of Sulfadoxine-Pyrimethamine and Amodiaquine given to children between 3-59 months. Reviews of IPT in children show benefits in reducing the number of malaria episodes and preventing severe disease and deaths. IPT in infants show 30% reduction in incidence. More research is required in prevention of malaria for bringing less costly drugs with limited side effects. Priority should be given to the use of non pharmacological measures to reduce the burden of disease, so that we can prevent the need for using drugs for prevention of malaria