Table 1 Antimalarial Prophylaxis Recommendations for Dive Related Travel
From: Safety of antimalarial medications for use while scuba diving in malaria Endemic Regions
| Prophylactic medication | Recommendation | Comments |
|---|---|---|
| Atovaquone-proguanil 250/100 mg daily | Primary regimen | • Lowest and most benign side effect profile |
| Doxycycline 100 mg daily | Secondary regimen | • Phototoxicity and esophageal effects make second line |
| • Very rare but real risk of reversible intracranial hypertension | ||
| Primaquine phosphate 52.6 mg daily | Alternative regimen | • Lower level of protective efficacy than other agents |
| • High pill burden | ||
| Mefloquine 250 mg weekly | Alternative regimen | • Prophylaxis of last resort |
| • High levels of CNS side effects may mimic DCS | ||
| • Possibility with test doses prior to travel or in treatment experienced patient | ||
| Chloroquine phosphate 500 mg weekly | Not recommended | • Geographically limited efficacy alone; still relatively low with proguanil |
| • Known association with seizures | ||
| • Theoretical possibility of eliciting hyperbaric oxygen seizure | ||
| • Other CNS side effects |