Background

Every year more than 1,500 travellers from the UK catch malaria and several of them die. The onset of serious illness can be rapid. The right antimalarial provides good protection. The risks are higher for children and pregnant women, and for people with ongoing medical conditions.

Do NOT forget you may also need vaccines and other health advice from a GP or travel clinic.

Which antimalarial to buy online?

No one type of recommended antimalarial works better than another. Some are daily tablets or capsules, some weekly. Some are started a few days before travel, others 10 days before. Some are continued for a month after returning home, others for only a week.

We offers Malarone (atovaquone/proguanil), Lariam (mefloquine), and doxycycline. These are now the most commonly recommended malaria prevention medications.

How to take antimalarials (tablets or capsules)

• Take the right antimalarial for the area you are going to.
• Start your tablets/capsules before entering a malaria zone. This may be a few days or up to 10 days before.
• Take the tablets/capsules absolutely regularly, preferably with or after a meal.
• Continue to take them for 4 weeks after leaving the malaria area. This period is reduced to 7 days for Malarone (atovaquone/proguanil).
• No antimalarial is 100% effective. Malaria risk can also be reduced by avoiding mosquito bites (details below).

Where are you travelling?

Selecting your destination above opens a country information page on the NHS Fit For Travel website. This page contains health information including vaccines and malaria precautions for that country. The 'malaria map' link shows high risk and low risk areas within that country (sometimes at different times of the year), and the 'Malaria' section includes more information including which malaria prevention tablets/capsules (prophylaxis) are recommended.

Antimalarial recommendations are based on malaria parasite (Plasmodium) drug resistance. It is important to take the medicine which is recommended for the area being visited. Drug resistance is becoming an increasing problem with the malaria parasite. The older preventative regimes including chloroquine, proguanil, and a combination of the two are now rarely effective, and are not generally prescribed.

Avoiding mosquito bites

Malaria is transmitted by mosquitoes which are themselves infected with the plasmodium parasite. Avoiding mosquito bites is an essential part of protecting yourself from malaria and some other tropical diseases, e.g. dengue fever, yellow fever, zika.

Mosquitoes can bite at any time of day. Most bites by malaria mosquitos occur in the evening and overnight between dusk and dawn. In contrast, dengue fever mosquitoes tend to bite during the day.

• Wear long-sleeved clothing and long trousers if you are out at dusk, dawn, and at night. Several companies sell insect resistant travel clothing pre-treated with insecticide (permethrin).
• Use insect repellent containing DEET on exposed skin and under thin clothing, particularly around the ankles. The best strength DEET is 50% - there is no added benefit to using higher concentrations. Other repellents containing picaridin, IR3535, or lemon eucalyptus are less effective than DEET and must be reapplied very frequently.
• Insect repellent room sprays, mosquito coils, and heating insecticide impregnated tablets all reduce the risk of bites, and should be used to kill mosquitoes in bedrooms before going to bed.
• Where possible sleep in screened rooms and use a mosquito net, preferably one impregnated with insecticide (permethrin). Mosquitos are deterred by air conditioning but not fans.
• Ultrasound devices, mobile phone apps, garlic, vitamin B, marmite, homeopathic products, tonic water, alcohol, tea tree oil, and citronella DO NOT prevent bites.

What are the symptoms of malaria?

Malaria symptoms start out similar to flu. Symptoms include fever, shivers, sweating, backache, joint pains, headache, vomiting, diarrhoea, cough, and sometimes delirium.

These symptoms may take a week or more to develop after you have been bitten by an infected mosquito.

• Seek medical advice if you get malaria symptoms for up to a year after exposure, even after taking antimalarials. Malaria is diagnosed with a simple blood test.
• If you are travelling in remote areas for prolonged periods it may be helpful to also carry a malaria treatment and/or a malaria testing kit with you. Discuss this with your regular doctor or a specialist travel clinic.

Pregnancy and malaria

Pregnant women are at a much higher risk of developing malaria and becoming very seriously ill with a higher risk of death for themselves or their unborn child. Pregnant women are strongly advised not to travel to a malaria zone, but if travel is completely unavoidable, they should take preventative medication and do all they can to avoid mosquito bites. The risk from malaria is much greater than any risk to the baby from taking antimalarial medication.

Taking Lariam

Most people can take Lariam (mefloquine) with no problems. However in a few people it can cause significant and serious side effects, which may last for several months after stopping. Suitability for taking Lariam is assessed in the online consultation. There is a patient alert card within the medicine pack which should be carried whilst taking Lariam. For further details see the Lariam Patient Leaflet.

There is a very rare theoretical risk of abnormal heart rhythm if Lariam (mefloquine) is taken at the same time as some other medications - please check this list.