What are the different malaria tablets?

Different types of malaria tablets - which will suit you best?

Malaria is a serious tropical disease that is both preventable and treatable yet it is one of the biggest killers of humans on earth. It is caused by a parasite known as the Plasmodium parasite which is carried and spread by the female Anopheles mosquito and is transmitted to humans when the mosquito bites a person in order to feed on their blood.

Malaria can cause high fever, chills and flu-like symptoms and if it is not treated quickly enough it can be fatal and if you are planning a holiday or a period travelling it is vitally important that you do your research and check if any of your destinations are in an area where there is a risk of contracting malaria.

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There is a four-step approach to the prevention of malaria:

  • A - awareness of risk. Researching the area(s) you will be visiting is part of this. It is also important to research which times of the day you will be most at risk, for example, the Anopheles mosquito is most active from dusk until done with it being most active around midnight; sleeping outdoors is an extremely risky thing to do. Mosquitoes like the dark and will hide in dark places during the day so they may well hide in your accommodation and come out at night. It is also useful to know that mosquitoes tend to live near unpolluted freshwater or saltwater, so mangrove swamps, streams and rivers are best avoided.

  • B - bite prevention is obvious and there are various different approaches that can help to achieve this. Sleeping under a mosquito net, keeping all doors and windows at your accommodation closed at all times, using insect repellant, ensuring that clothes cover your skin and are made of fabric thick enough to stop an insect bite from penetrating to the skin.  Finally, if you are in a position to do so, stay in air conditioned accommodation. It will be more comfortable for you at night but mosquitoes hate the cold!

  • C - chemoprophylaxis. This is the use of drugs that can be taken to prevent a person from developing malaria should they be bitten by an infected mosquito. It is important to consult your GP in plenty of time before you travel as there are a number of medications available and for some to be effective, you will need to start taking them a couple of weeks before travelling.

  • D - diagnosis if you think that you may have contracted the disease. The sooner you can begin treatment the better the prognosis is likely to be.

 

What are malaria pills?

There are two types of malaria tablets, those which are taken to prevent your contracting the disease which are prophylactic drugs and drugs which are taken to treat the disease if a person is infected.

 

Prophylactic medication

When choosing a prophylactic drug for malaria, different countries may recommend different drugs or combinations of drugs and it is important that you check which drug(s) are recommended for your area of travel. This CDC link  may be of use:

https://www.cdc.gov/malaria/travelers/country_table/a.html

It is also important to realise that none of the antimalarial medications available is 100% effective and so measures to prevent being mitten must be used concomitantly with the drugs.

Malaria prophylactics may also interact with other drugs you may be taking and it is important to be sure that you are not allergic to the antimalarials.

 

Atovaquone/Proguanil (Malarone)

This type of antimalarial can be purchased from a pharmacy over the counter. The dose for this is 1 tablet daily for adults (check for children) and the treatment begins 1 - 2 days before travel. It continues daily during travelling and continues for 7 days after leaving the area.

It is particularly useful if you are travelling at short notice as the course of medication only needs to begin 2 days prior to travelling. In addition, the medication only needs to be continued for 7 days after returning and the drug is well tolerated with side effects being rare.

The downside is that the drug cannot be used in pregnancy or if a woman is breastfeeding and it is not suitable for infants under 5kg. If a person has kidney problems the drug is not suitable and the drug tends to be more expensive than other options.

 

Chloroquine

This drug is also available over the counter at pharmacies; dosing of 300mg once per week for adults (check the dosage for children) beginning one week before travelling and continuing for four weeks following return from the area.

Some people may prefer weekly medication rather than having to remember every day but it is important that the medication is taken on the same day every week. This drug can be used throughout pregnancy and if a person is already taking it for a rheumatic condition they may not need to take additional medication.

The downsides are that chloroquine is not used very often anymore as a result of P. falciparum, the most dangerous and common form of the parasite,  having become resistant to it. In addition, it may make psoriasis worse, is not suitable for last minute travellers and if a person is only taking a short trip they may not want to take the medication for so long on their return.

 

Doxycycline

Dosing begins 1 - 2 days before travelling and is 100mg daily for adults (check for children). Dosing should continue daily for four weeks after leaving the area.

Again, this is good for last minute travellers and it is also the least expensive of the antimalarials. Some people may be taking the drug long term for the prevention of acne and so may not need any other medication. In addition, as doxycycline is an antibiotic it may protect the user against other infections whilst travelling.

This medication is not suitable for use by women who are pregnant or breastfeeding and if a woman is prone to thrush or other vaginal yeast infection they may prefer to use another antimalarial. This medication may also cause sensitivity to the sun and stomach upsets.

 

Mefloquine

The usual dose for an adult is 250mg orally once per week beginning 1- 2 weeks prior to travelling, once weekly during travel and for four weeks after leaving the area.

This is a good choice for long trips as it has to be taken weekly and not daily; it is also suitable for use during pregnancy.

As with chloroquine, parasites in some areas have developed resistance to this medication. It is not suitable for people with seizure disorders, some psychiatric disorders and some heart conditions.

 

Diagnosis of malaria

As outlined already, if you think you may have contracted malaria it is vital to seek diagnosis and treatment as soon as possible in order to achieve the best outcome. Provided the diagnosis and treatment is prompt, then a person can expect to have a full recovery.

Your doctor will need to find out which type of malaria parasite has infected you, where you contracted the disease, whether you are pregnant, which prophylactic medication you have used as well as taking into consideration your age and physical condition. These details will enable your doctor to decide on the best course of action to tackle the infection.

The  GP will first ask for a blood test, firstly to confirm that you have malaria and secondly to confirm which strain you have contracted.  Immediately this is known, treatment can begin.

Once the diagnosis is confirmed your GP has to notify the public health authorities and if you have travelling companions you must tell them that you have the disease in order that they can be checked over and if necessary treated.

 

Complications of malaria

If you are unlucky enough to have contracted P. falciparum malaria, it is more likely that you will develop complications. The complications include:

  • Seizures and a change in consciousness levels
  • Anaemia
  • Breathing problems or fluid on the lungs
  • Kidney problems
  • Low blood sugar
  • Blood clotting issues
  • Sepsis (blood poisoning)
  • Organ failure

 

Treatment for malaria

Treatment for malaria involves administering an appropriate medication that can remove all the parasites from the blood.

If you have been infected by the P. falciparum parasite and this is the cause of your malaria, it is highly likely that you will be taken into hospital whereas other strains of malaria can be treated at home. Severe malaria or complications from malaria needs intensive care treatment.

When treating P. falciparum, the following medication is most commonly used:

  • Artemisinin combination therapy (ACT) which is given for malaria without complications

  • Atovaquone-proguanil which is also used for malaria without complications

  • Quinine which can be used for malaria without complications as well as severe malaria

  • Artesunate is given for malaria with complications and is administered intravenously. This may be given alongside doxycycline or clindamycin with quinine.

It may take a few days for all the parasites to be destroyed and daily blood tests will enable the doctors to see how well you are progressing.

In the case of other forms of malaria, chloroquine is used as a treatment.  If you happen to be suffering from malaria caused by P. Vivax or P. ovale, these varieties of the parasite can remain in the liver after the bloodstream is clear so after taking chloroquine you will be treated with primaquine. This will clear the parasites from the liver and prevent the disease from recurring.

G6PD (glucose - 6 - phosphate dehydrogenase) deficiency is a genetic disorder that a person may or may not be aware of. There is a higher incidence of this condition in people who have African, Asian and Mediterranean origins and it is more common in men than women. The deficiency of G6PD means the red blood cells are unable to work effectively. The absence of this enzyme can cause haemolytic anaemia which causes the red blood cells to break down.

If a person is suffering from this disease then they cannot be treated with primaquine as it can lead to anaemia or other serious health problems.

As a rule, malaria will be cured relatively clearly but malaria may return if all the parasites have been left behind. If symptoms resume it is important to seek treatment again.

 

Emergency standby treatment

If you are travelling to a particularly remote region of the world which is a malaria risk area, it may be possible for your GP to prescribe treatment for malaria before you leave. The reason for this may be that there will be little or no access to medical care in the region you are visiting.

Emergency standby medication which you may be prescribed are:

  • Atovaquone with proguanil

  • Artemether with lumefantrine

  • Quinine and doxycycline

  • Quinine and clindamycin

Prescribing emergence medication may be better is carried out by a specialist in travel health.

 

Conclusion

You can take as many precautions as humanly possible to prevent being bitten and to prevent your contracting the disease but prevention and prophylaxis are not infallible. If you are bitten by an infected mosquito then the disease can develop within 7 - 30 days; if you have been taking prophylactic medication this period can be as long as a year. If you develop symptoms at any time, up to a year after travelling to a malaria risk area, it is vital that you seek medical advice as soon as possible in order that diagnosis and treatment for malaria can begin.

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