What is malaria prevention (prophylaxis)?

Malaria happens when a parasite from a mosquito bite causes an infection. Malaria medication works by preventing the malaria parasite from setting itself up to grow inside your liver and bloodstream. Essentially, it stops the development of malaria in your body. 

Some countries have a high risk of malaria. If you’re traveling abroad where the disease is common, it’s important that you take steps to protect yourself. The best way to avoid malaria is combining malaria-preventing medication (chemoprophylaxis)  with methods to help you avoid getting bitten by malaria-carrying mosquitos.

How you take malaria-prevention treatment will depend on which medication you’re using. You may need to take tablets every day or on a weekly basis but you’ll always need to make sure you take the full course of the tablets. 
Sometimes your doctor may suggest you take the tablets as a trial before you travel. Usually this is to check if you have any serious side effects and if you need to change to another type of malaria medication. 

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What are my choices for anti-malaria tablets?

There are a few different malaria tablets available: 

• Malarone (also known as atovaquone/proguanil) – this medication contains two active ingredients called ‘atovaquone’ and ‘proguanil hydrochloride’. It kills the malaria parasite as soon as it enters the bloodstream and stops the disease from developing. Superdrug offers generic malarone (atovaquone and proguanil) and branded Malarone. Both contain the same ingredients and work the same way.

• Doxycycline – doxycycline is an antibiotic. It belongs to a group of medicines called tetracycline antibiotics and is very good at killing the parasite that causes malaria. It’s a prescription medication, so you can’t buy it over the counter. Speak with your GP or use an online doctor service if you want to try this medication. 

• Lariam (also known as mefloquine) – lariam tablets are a medication used to help you avoid getting malaria. It contains mefloquine, an ingredient which kills the malaria parasite. Lariam needs to be taken once a week to protect you from malaria. However, due to the serious and severe side effects Lariam can cause, this treatment is no longer offered by Superdrug Online Doctor. 

• Chloroquine and proguanil – a combination of antimalarial medications called chloroquine and proguanil is also available, although these are rarely recommended now  because they’re not as good at protecting against the most common and dangerous type of malaria parasite, Plasmodium falciparum. However, chloroquine and proguanil may sometimes be given depending on the country where this particular parasite is less common, such as India and Sri Lanka. But on the whole, it is not usually given or widely available.

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How do I know which anti-malarial drugs I need?

Taking the right malaria tablets depends on where you are travelling to, your reaction to the medication, and your current health. 

Malarone (and generic Malarone) – can be taken if you’re travelling to any/all high risk areas.  But, it’s not suitable for you if you’re allergic to any of the ingredients in Malarone or you have severe kidney problems. It’s also important to note that this medicine should not be taken by pregnant or breastfeeding women. There’s just not enough clear evidence to say that this is safe as of yet.

Doxycycline – is recommended to use if you’re travelling to any/all high risk areas. 

This medication is not recommended if you:

• are a child under 12

• have had an allergic reaction to doxycycline, or a similar antibiotic in the past

• are a pregnant or breastfeeding woman

• are likely to be exposed to strong sunlight or ultraviolet light

• have liver problems or are taking other medicines which affect your liver 

• have severe kidney problems 

• have a condition called ‘myasthenia gravis’ 

• have porphyria (a rare genetic disease of blood pigments) 

• have systemic lupus erythematosus 

• have sucrose intolerance

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How do I use malaria tablets?

You should always make sure you take your tablets on time and as your doctor recommends. This will help to make sure the risk of you getting malaria is as low as possible. 

It’s also a good idea to try the malaria tablets as a short trial (an extra week) before travelling so you can see if you get any serious side effects and you have time to switch to another medication.

Malarone 

• For adults taking malarone, the usual dose is 1 adult-strength tablet a day. 

• For children, it is also once a day, but your doctor will need to check your child’s weight to make sure the dosage is correct. 

• You should start taking malarone at least 1 or 2 days before your trip, taken every day you are there and for 7 days after you return home from holiday. 

• If you’ve never had it before, it’s a good idea to start taking it 7 days before you leave to check for side effects.

Doxycycline 

• The dose for doxycycline is usually 100mg once a day, as a tablet or capsule. 

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What’s the difference between these tablets and malaria treatment?

Most malaria prevention tablets can also be used to treat malaria. But, if you’ve taken tablets to avoid getting malaria and you’ve gotten it anyway, it’s important to tell your doctor which ones you already took. This is because the ones you’ve already taken will not work in treating it. 

Treatment of malaria will largely depend on where you caught it, what your symptoms are, the type of malaria you have, your age and if you’re pregnant. Being treated for malaria can leave you feeling very weak and very tired which can last for several weeks. 

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Can malaria tablets give me side effects?

Malaria tablets can give you side effects, no matter which ones you take. Not everyone will get them though. It’s important to be able to recognise them and also consider if you’re having symptoms of malaria instead.

Common side effects of Malarone (atovaquone and proguanil): 

• feeling or being sick

• headaches

• skin rash

• mouth ulcers

• sleeping difficulties

• unusual dreams

• dizziness

• feeling depressed

• loss of appetite

• rash

• cough

• fever

 Common side effects of Doxycycline:

• feeling or being sick

• heartburn

• thrush

• sunburn as a result of light sensitivity

The symptoms of malaria can be similar to the side effects listed above and usually start off quite mild. 

You may not realise you have it so it’s important to look out for the following:

• symptoms of flu-like illness 48 hours, or 7 to 18 days after being bitten by a mosquito

• fever 

• vomiting

• headache

• feeling shivery or shaking

• muscle pains

• diarrhoea

If you think you have malaria, it’s really important that you get a diagnosis and treatment as quickly as you can. Sometimes the disease can be so serious that it can become life-threatening within 24 hours. 

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How else can you prevent malaria?

To increase your chances of avoiding getting malaria, you can try the A B C D method: 

• Awareness of risk – are you at risk of getting malaria? Find out if the places you’re travelling to have a risk of getting malaria. 

• Bite prevention – avoiding being bitten by mosquitos. You can do this by using an insect repellent (such as DEET), making sure your arms are covered with long sleeves, covering your legs by wearing trousers instead of shorts and using a mosquito net – try to get one that has added insecticide.

• Check whether you need to take malaria prevention tablets – if you do, make sure you take the right antimalarial tablets at the right dose, and finish the course.

• Diagnosis – if you think you have malaria symptoms, get immediate medical attention. Sometimes symptoms can happen even up to a year after you return home from travelling. 

If you want to try an insect repellent, make sure you use a DEET spray. This is usually available from supermarkets or in a pharmacy. Adults, children and pregnant women can us this spray but make sure not to give it to babies who are less than 2 months old. Spray it on any skin (but not the eyes or lips) that is uncovered, and put sunscreen on after you use the DEET spray, not before.

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Sources

Fit for travel (2019). Malaria. [online] Available at https://www.fitfortravel.nhs.uk/advice/malaria [accessed 9 August 2019]

NHS (2018) Malaria treatment. [online]. Available at: https://www.nhs.uk/conditions/malaria/treatment/ [accessed 9 August 2019]

NHS (2018). Malaria prevention. [online]. Available at: https://www.nhs.uk/conditions/malaria/prevention/ [accessed 9 August 2019]

Fit for travel (2019). Destinations. [online]. Available at: https://www.fitfortravel.nhs.uk/destinations.aspx [accessed 9 August 2019]

Medicines.org.uk (2019) Doxycycline. [online]. Available at: https://www.medicines.org.uk/emc/product/4063/smpc [accessed 9 August 2019]

Medicines.org.uk (2019) Atovaquone/Proguanil Hydrochloride. [online]. Available at: https://www.medicines.org.uk/emc/product/9902/smpc [accessed 9 August 2019]

Medicines.org.uk (2019) mefloquine hydrochloride. [online]. Available at: https://www.medicines.org.uk/emc/product/9670 [accessed 9 August 2019]

Medicines.org.uk (2016) Chloroquine and Proguanil. [online]. Available at: https://www.medicines.org.uk/emc/product/5494/smpc [accessed 9 August 2019]

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