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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