Travelling with anti-malarial medication

Malaria: prevention and medicines information

Malaria is a serious but preventable disease that originates in tropical and subtropical countries.  It can develop after being bitten just once from an infected mosquito. In 2015, The World Health Organisation (WHO) reported over 212 million cases of malaria worldwide, and approximately 429,000 deaths… Because of the seriousness and severity of malaria infections, it’s important to prevent getting malaria. If you are travelling to a tropical climate you should use the ABCD prevention approach to protect yourself.

The ABCD Approach

A – Awareness of the risk

You can check the FitForTravel website www.fitfortravel.nhs.uk which gives you up to date information on your malaria risk for your travel destination. Ideally you should check 4-6 weeks before departure to give yourself time for medications if needed. An alternative website to use is www.travelhealthpro.org.uk. If you need anti-malarials at a much shorter notice The Doctor Service may be able to arrange this for you.

 B – Bite prevention

This is your best form of prevention and there are several ways you can prevent being bitten by mosquitos when you are travelling.

  • Clothing with long sleeves including long trousers to cover the skin can help prevent bites. Whilst mosquitoes usually bite after sunset, this does not guarantee they do not bite during the day. Take care to avoid being bitten at all times.
  • Insect Repellent that contains 20% to 50% concentration DEET (N,N-Diethyl-m-tolumide) is known to be the most effective against mosquitoes. The concentration of DEET will dictate how long it will provide protection. You should not use on infants below two months old and but it is considered safe to use in pregnancy.
  • Alternatives to DEET can be used if not tolerated but could be less effective.  When both sunscreen and DEET are required, DEET should be applied after the sunscreen. 30 to 50 SPF sunscreen should be applied to compensate for DEET-induced reduction in SPF.
  • Spraying insecticides in your room before you go to bed to kill any mosquitoes that may have entered your room during the day. You can also burn pyrethroid coils and heat insecticide impregnated tablets also.
  • Mosquito nets impregnated with insecticide (pyrethroid or pyrethrum) should be used if you are sleeping out doors or in an unscreened room (no gauze over windows or doors). Ensure to look after your net as insecticide can wear away through cleaning and handling.
  • Air conditioning in your room will help make the environment uninhabitable as mosquitoes thrive in warm temperatures.

C – Check for Chemoprophylaxis (Anti-Malarial Medication)

Anti-malarials help to protect you from developing malaria if you are bitten. See below under Treatment Options for the safest anti-malarial options. These reduce the risk of getting malaria by approximately 90%, and are most effective when combined with Bite Prevention measures.

The type of medication prescribed depends on your destination of travel and one which is most suited to you, taking in consideration any other health conditions or concerns you may have.

You should ensure to complete the course of any treatment so it is effective as possible. This often means continuing the course for a specified period of time once you have left the high risk zone.

D – Diagnosis and prompt treatment

Seek immediate medical attention if you think you may have malaria, even if it’s after you’ve returned home, especially if you’re getting some of the common symptoms mentioned in our malaria articles. It is regarded as a medical emergency and patients can deteriorate rapidly over a few days.

The treatment for malaria is very different to prevention treatment for malaria, so you should not use anti-malarial treatment to treat active malaria.

Malaria Prevention – Medication Options

The fit for travel website will usually tell you what your different options are for the area that you’re travelling in. The NHS does not provide medication for the prevention of malaria but it can be given on a private prescription or by booking with a travel clinic. Alternatively, the easiest and most convenient way is to do it online, for example through The Doctor Service.

Doxycycline

Doxycycline is a commonly-used option, it is an anti-malarial as well as an antibiotic, and it is available on-prescription through The Doctor Service. Dosage is 100mg (1 tablet) taken once a day and you should begin taking it 1-2 days before travel, and continued 4 weeks after leaving the malaria risk zone.

We recommend taking the tablet in the morning with breakfast and plenty of water. This medication is not suitable for those who are pregnant or breast-feeding. Although this medication is usually well-tolerated, it is important to note that Doxycycline is sometimes associated with increased sensitivity to sunlight – so don’t forget sun cream if you’re out in the sun!

Malarone

Malarone is another popular option, which is one of the most popular used anti-malarials. It contains a combination of two medications that prevent malaria – Proguanil and Atovaquone.

Adults should take 1 tablet at the same time each day and you need to start 1-2 days before travel and continue for one week after leaving the Malaria-risk zone. It is associated with a very low risk of side effects and is the best tolerated. Malarone is again prescription only, and is available from The Doctor Service Here.

Other options

Should neither of these options prove suitable, other anti-malarial drugs are available. Malarone and Doxycyline certainly have the lowest risk of side effects, and can be used in most parts of the world. At The Doctor Service, we do not prescribe other anti-malarials. There are more checks required due to more side effects and risks associated with using these medications.

We hope you enjoy your time abroad if you’re going away! Whether it be for work or leisure, if you are travelling to an area with malaria, it is important to take anti-malarials, avoid bites, and get medical help as soon as possible should you feel ill.

Edited by Dr Kiran Sodha & The Doctor Service at TheDoctorService.co.uk

References

  1. NHS fit for travel: http://www.fitfortravel.nhs.uk/advice/malaria.aspx
  2. NHS choices: http://www.nhs.uk/conditions/Malaria/Pages/Introduction.aspx
  3. BNF section 5.4.1: Anti-malarials
  4. MHRA
  5. https://cks.nice.org.uk/malaria#!scenario
  6. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-malaria-and-pregnancy.pdf
  7. https://www.evidence.nhs.uk/search?q=UK%2Bmalaria%2Btreatment%2Bguidelines
  8. http://www.fitfortravel.nhs.uk/advice.aspx
  9. https://www.gov.uk/government/collections/malaria-guidance-data-and-analysis
  10. http://www.who.int/mediacentre/factsheets/fs094/en/
  11. http://www.nhs.uk/Conditions/Malaria/Pages/Introduction.aspx
  12. https://travelhealthpro.org.uk/factsheet/52/malaria
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