Stay safe and order malaria tablets before you travel

Malaria is a dangerous disease common to tropical countries. Once you have it, it’s difficult to cure. So, it’s best to avoid it in the first place. Our doctors can provide you with effective malaria prevention drugs.


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Virginia Chachati

Reviewed by Virginia Chachati MPharm
(2013, University College London)
GPhC Registration number: 2087654

Information last reviewed 08/01/21

About

What is malaria?

Malaria is a mosquito-borne disease caused by parasites of the plasmodium family. When travelling abroad to a region where malaria is known to be prevalent, you will need to take antimalarial medication and avoid being bitten by mosquitoes. There are five different types of malaria, and the type of antimalarial you take will depend on the area you are travelling to and the type of malaria that is known to be there.

What causes malaria?

Plasmodium parasites that cause malaria are in the saliva of female mosquitoes. When a mosquito bites you for a blood meal, the parasites get into your body. Once in the blood, the parasites move towards the liver to grow and multiply in the liver cells. The parasites are then released in significantly higher numbers back into the bloodstream, where they invade and rapidly multiply in red blood cells until the cells explode. The death of red blood cells causes symptoms of malaria. The disease is not immediately apparent, as it takes around seven days after being bitten by a malaria-carrying mosquito for the malarial parasite to begin multiplying in the blood.

Which countries have malaria?

More than 100 countries are known to be malaria hotspots. The disease is particularly prevalent in Africa, South Asia, Southeast Asia, Oceania, the Middle East, the Caribbean, Central America and South America.

Is malaria seasonal?

In many countries, malaria reaches its peak-transmission during and after the rainy season, because mosquitoes breed in hot, wet and humid climates.

How dangerous is malaria?

Malaria can be very dangerous and, in some cases, fatal. Plasmodium falciparum, which is prevalent in sub-Saharan Africa, is the most dangerous malaria-causing parasite and is responsible for the most malaria deaths globally. It is possible to treat and cure malaria if caught early, so it is essential to recognise the early symptoms. However, some types of malaria act very quickly and lead to complications including swelling of the brain, anaemia, kidney failure, liver failure, a ruptured spleen, low blood sugar, fluid on the lungs (pulmonary oedema), acute respiratory distress syndrome (ARDS), or a sudden drop in blood pressure leading to shock. These complications can be fatal.

Symptoms

What are the symptoms of malaria?

Malaria symptoms develop seven days after the initial mosquito bite. Some malaria parasites can remain dormant in the liver, with symptoms taking up to a year to develop. If you have recently travelled to a malaria zone, you should seek immediate medical help if you develop any of the following symptoms:

  • A high body temperature of 38 degrees Celcius or above
  • Feeling hot and shivery
  • Headaches and muscle pain
  • Vomiting or diarrhoea
  • Feeling generally unwell

More severe symptoms of malaria can indicate serious health complications and require urgent medical attention. These include:

  • Severe exhaustion
  • Difficulty breathing
  • Severe dehydration
  • Seizures (also known as convulsions or fits)
  • Confusion
  • Yellowing of the skin and eyes (Jaundice)
  • Blood in the urine

What is malaria like?

Early malaria symptoms can feel like having a bad bout of flu, full-body aches and pains, a high temperature, a feeling of being generally unwell, vomiting, diarrhoea and often a bad headache from dehydration. It is essential to seek medical help if you experience any of these symptoms and have recently travelled to a malaria zone.

Treatment

How to avoid malaria?

Be aware of your risk of catching malaria before travelling to a region where malaria is known to be prevalent. You should take all possible measures to avoid being bitten by mosquitoes. This includes choosing appropriate accommodation which is well ventilated and away from damp, dark places or stagnant water sources. Ask if your accommodation will provide mosquito nets or if you need to bring your own. Mosquito nets can come impregnated with mosquito repellent. 

Other mosquito repellents come in the form of air sprays and electric plugins. There are also coils that you can burn outdoors to repel mosquitoes. While it is tempting to choose shorts and sleeveless tops when visiting a hot, humid climate, try to keep your skin covered with loose, long, light coloured clothing. Also, apply a mosquito repellent to your skin, preferably one containing 50% DEET. Protection is essential at dusk and night, as mosquitoes love to feed at these times, and it may be worth staying indoors in the evenings to avoid getting bitten.

Also, you will need to take your antimalarial medication with you when travelling to a malarial area. Speak to your doctor to find out which antimalarial they recommend for your trip. Your doctor will advise you on how to take your antimalarials effectively. You may need to start taking your antimalarials before you leave for your trip, during your trip and continue taking them after your trip.

How is malaria treated?

If you develop malaria symptoms, you will need to go to a hospital for a blood test to confirm you have the disease. It is possible to treat a non-severe case of malaria at home. The type of treatment will depend on the type of malaria, the severity of symptoms, and which antimalarials you have taken. A severe case of malarial requires treatment in a hospital. In the UK, the standard treatment for severe malaria in a hospital is intravenous artesunate, while they monitor your heart, lungs, kidneys and blood sugar levels.

Antimalarial medication

The type of antimalarial medication you take will depend on where you are travelling to, the length of your trip, and the cost, so it is essential to speak to a doctor about which one is best for you. The three main types of antimalarial are Mefloquine (Lariam),  Malarone (atovaquone-proguanil) and Doxycycline

There is a fourth type of antimalarial, Chloroquine, however it is not as effective due to resistance. Chloroquine is a weekly tablet that you start 1 - 2 weeks before you arrive in a malaria zone, take weekly during your stay and for four weeks after leaving the malarial area. It is best suited to long trips, as it only needs to be taken once a week, and is suitable for use in pregnancy.

Malarone is a more expensive option that is better suited to short trips or last-minute travel. You should start taking Malarone 1 or 2 days before travel, each day during your trip and for seven days after you leave the malarial area. Malarone has few side effects and is also available in a paediatric form suitable for children. Do not take Malarone during pregnancy.

Doxycycline is much cheaper than other antimalarials. It is an antibiotic that should be started a day or two before travel, taken once daily throughout your trip and daily for four weeks after leaving the malarial area. It may cause side effects in some people, and should not be used by children under 12 years old or by women who are pregnant or breastfeeding.

Can I still get malaria if I take antimalarials?

When taken correctly, antimalarials provide adequate protection against malaria. However, no antimalarial is 100% effective, and it is still possible to contract malaria while taking them. Therefore, it is a good idea to take extra precautions against being bitten by mosquitoes. For example, use a mosquito net over your bed at night and 50% DEET on your skin to prevent mosquito bites.

Which type of antimalarial do I need to take?

The type of antimalarial you need depends on the area you are travelling to, as different types of malaria are prevalent in other areas of the world. We recommend you consult a doctor to make sure you take the right antimalarials for you. For a rough guide, this map will give you an idea of which antimalarials are suitable for which country.

Are malaria tablets a prevention or a cure?

Malaria tablets help prevent and cure malaria. They are available for purchase on prescription from Dr Felix as a preventative measure for travellers.

How long do I need to take antimalarials for before and after my trip?

The length of your course will depend on the type of antimalarial you are taking. You do not need to take all three types of antimalarial.

You take Chloroquine weekly, starting 1 to 2 weeks before your trip, during your trip and four weeks after departing from the malarial area. 

With Malarone, you take it daily starting 1 or 2 days before you arrive in a malarial area, taken each day whilst there and for seven days following your departure. 

Doxycycline is taken daily and should be started 1 or 2 days before travel, taken each day whilst there and continued for four weeks following your return.

Side Effects

What are the complications of antimalarials?

Like all medicines, antimalarials can cause side effects in some people. These side effects are usually mild and easy to manage. 

Doxycycline tends to cause side effects such as yeast infections, and your skin and eyes may be more sensitive to the sun. 

The most common side effects of antimalarials are gastrointestinal. You may experience nausea or sickness when you take your daily dose. It is recommended you take Malarone with food to avoid this side effect.

Staying hydrated where necessary can help manage headaches. Chloroquine can cause around 1 in 10 people to experience sleeping problems. Discuss side effects with your doctor, as a different antimalarial might be better suited to you.

If you experience an allergic reaction to your antimalarial, stop taking it and seek medical help immediately. Allergic reaction symptoms include difficulty breathing, wheezing, chest pain, swelling of the face, lips, tongue, throat, hands or feet, fever, or rash.

Will my other medications interfere with my antimalarials?

Before taking antimalarials, you should tell your doctor if you are taking any other medications. Some medications may interact with antimalarials, including:

  • Halofantrine
  • Quinine or quinidine
  • Quinapril
  • Beta-blockers and calcium-channel blockers
  • Antihistamines
  • Antidepressants, selective serotonin reuptake inhibitors, bupropion and antipsychotics
  • Epilepsy medications including sodium valproate, carbamazepine, phenobarbital, and phenytoin
  • Ketoconazole
  • Rifampicin, penicillin, tetracycline and cephalosporins
  • Efavirenz
  • Tramadol
  • Medicines for diabetes or blood-clotting disorders, such as anticoagulants
  • Kaolin
  • Sucralfate
  • Oral contraceptives
  • Barbiturates
  • Ergotamine or methysergide
  • Typhoid vaccine
  • Ciclosporin
  • Methoxyflurane
  • Antacids and other medicines containing aluminium, calcium, iron, bismuth or zinc salts
  • Retinoids
  • Metoclopramide
  • Warfarin
  • Etoposide

To be safe, let your doctor know if you are taking any of the above medications.

Is it okay to drink alcohol when taking antimalarial medication?

While taking Malarone or Chloroquine, you may feel drowsy or dizzy after drinking alcohol. You should avoid drinking alcohol while taking Doxycycline, as alcohol can reduce its effectiveness.

Are malaria tablets safe to use during pregnancy?

Chloroquine is the only antimalarial that you can take any time during a full pregnancy term. Mefloquine is an alternative you can take but only after the first 12 weeks of pregnancy. Your doctor will be able to advise you independently. Generally, the World Health Organisation (WHO) recommends that pregnant women avoid travelling to areas with a high risk of contracting malaria. It can be dangerous to both mother and baby. Malaria can increase the risk of miscarriage, premature birth, restricted growth or stillbirth.

Will antimalarials make me drowsy?

Antimalarials can make you feel drowsy, and more so if you drink alcohol with them. You should limit your alcohol intake when taking antimalarials and make sure to stay well hydrated at all times.

Q&A

Do commercial pilots need to take antimalarials all the time?

Advice about malaria prevention for pilots and aircrew depend on their travel routes and length of stay. The crew are cautioned to take precautions against mosquito bites but do not have to take antimalarials all the time if they do not wish to do so. It depends on the locations they travel to and their risk exposure.

What are the risks of long term use of antimalarials?

Antimalarials are generally used for a short time, to protect against malaria while travelling. The risks of long-term use are specific to each type of antimalarial and vary from person to person.  Therefore it depends on which antimalarial you will take and how long you intend to be in malarial risk areas.

How long can I safely take antimalarials for?

You can use Doxycycline safely for up to two years. Malarone should not be in use for longer than one year. Chloroquine should be limited to short-term use only, as its use in the long term carries the potential risk of health complications. If you plan to take an extended trip to a malaria zone, speak to your doctor for advice on which antimalarials to take.

Can I get antimalarials on the NHS?

Antimalarials are not available on the NHS for preventative purposes. The NHS can prescribe antimalarials to treat malaria.

Can you catch malaria in the city?

Malaria is prevalent in many cities across the world and spreads quickly in areas of dense population. Malaria transmission within a country can be unpredictable. It is best to be safe and take antimalarials regardless.

Can children take malaria tablets?

Chloroquine and Malarone are available for use in children depending on their weight. Doxycycline is only for use in children over the age of 12.

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