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Malaria prophylaxis — what can be given to breastfeeding mothers?

Which antimalarial medicines should be recommended for women who are breastfeeding?

AAdequate malaria prophylaxis is important for a breastfeeding mother and her child when travelling to malaria-endemic areas. If travel during the lactation period is unavoidable, the appropriate malaria prophylaxis must be primarily selected according to efficacy rather than safety during breastfeeding.

Chloroquine, proguanil and mefloquine are considered compatible with breastfeeding, and limited data indicate that atovaquone may be used if the infant weighs at least 5kg.

Short-term use of doxycycline is unlikely to be harmful to a breastfed infant; however, malaria prophylaxis with doxycycline is likely to be required for at least five weeks. It is recommended that doxycycline be avoided during lactation unless there are no suitable prophylactic alternatives available.

In addition to chemoprophylaxis, all usual measures to reduce the risk of mosquito bites, including the use of effective insect repellents, are strongly recommended.

Although many of the antimalarial drugs pass into breast milk in small amounts it is vital that separate prophylactic treatment, at the full recommended dose, is also given to the infant.

This information relates to full-term and healthy infants. Evidence in pre-term infants is lacking. If the infant is pre-term, of low birth weight or has other medical problems, then specialist advice should be sought.

This FAQ is taken from a “Medicines Q&A” produced by UK Medicines Information. The full document, including references, is available from www.nelm.nhs.uk (prepared November 2012)

Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11117622

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