U.S. Department of Defense


Date of this Version



Published in Clinical Infectious Diseases (2002) 35: p. 825-33. DOI: 1058-4838/2002/3507-0007


The increasing prevalence of resistance to antimalarial drugs reduces options for malaria prophylaxis. Atovaquone/proguanil (Malarone; GlaxoSmithKline) has been 195% effective in preventing Plasmodium falciparum malaria in lifelong residents of areas of holoendemicity, but data from persons without clinical immunity or who are at risk for Plasmodium vivax malaria have not been described. We conducted a randomized, double-blinded study involving 297 people from areas of nonendemicity in Indonesia who migrated to Papua (where malaria is endemic) 26 months before the study period. Subjects received prophylaxis with 1 Malarone tablet (250 mg of atovaquone and 100 mg of proguanil hydrochloride; np 148) or placebo (np149) per day for 20 weeks. Hematologic and clinical chemistry values did not change significantly. The protective efficacy of atovaquone/proguanil was 84% (95% confidence interval [CI], 44%–95%) for P. vivax malaria, 96% (95% CI, 72%–99%) for P. falciparum malaria, and 93% (95% CI, 77%–98%) overall. Atovaquone/proguanil was well tolerated, safe, and effective for the prevention of drugresistant P. vivax and P. falciparum malaria in individuals without prior malaria exposure who migrated to Papua, Indonesia.