Reviewed by GPhC Pharmacist at Priory Pharmacy, York
Malaria is the most serious mosquito-borne disease affecting UK travellers. Each year, the UK reports about 1,500 to 2,000 cases of malaria brought back from abroad. Most of these cases happen in travellers who did not take antimalarial tablets, or who did not take them correctly.
Falciparum malaria is the most dangerous type. It is common in sub-Saharan Africa. It is a medical emergency. Without fast treatment, it can cause:
- Cerebral malaria (swelling in the brain)
- Severe anaemia (low red blood cells)
- Failure of multiple organs
- Death within 24 to 48 hours of symptoms starting
Choosing the right antimalarial tablet is not simple. A clinician needs to look at:
- Where you are travelling to
- Your exact itinerary
- Drug resistance in that country
- Your medical history
- Other medicines you take
- How well you tolerate certain side effects
The Five Types of Malaria Parasite
Malaria is caused by tiny parasites called Plasmodium. Five types can make people ill:
- P. falciparum – causes most severe and fatal malaria cases. Common in sub-Saharan Africa. This is where most UK cases come from.
- P. vivax – common in South Asia and parts of Latin America. It can hide in the liver and come back months or years later.
- P. ovale – less common, but still important.
- P. malariae – less common, but still important.
- P. knowlesi – found in forested areas of Southeast Asia. It normally infects monkeys.
Antimalarial Tablets: A Simple Guide
Atovaquone-Proguanil (Malarone)
- Works very well against P. falciparum, even in areas resistant to other drugs.
- Usually well tolerated.
- Stops the parasite by blocking its energy production and folate use.
- Timing: Start 1–2 days before travel. Continue for 7 days after leaving the risk area.
- Good choice for travellers who are leaving soon, or have a fixed, short trip.
- Side effects: Mainly stomach upset.
- Caution: Not recommended if you have severe kidney problems.
Doxycycline
- A daily antibiotic tablet.
- Works well against P. falciparum in most areas.
- Bonus: also helps protect against some other infections, like leptospirosis and some tick-borne diseases.
- Timing: Start 2 days before travel. Continue for 4 weeks after returning home.
- Side effects:
- Sun sensitivity – avoid strong sun and use high-SPF sunscreen.
- Can irritate the food pipe – take the tablet standing or sitting up, with a full glass of water.
- Caution: Not for pregnant women or children under 12.
Mefloquine (Lariam)
- Used to be very common, especially where chloroquine resistance is high.
- Still works well in many areas.
- Side effects: Can affect mental health. This includes vivid dreams, poor sleep, anxiety, low mood, and rarely psychosis.
- Caution: Not suitable if you or your family have a history of:
- Mental health conditions
- Seizures
- Certain heart rhythm problems
- Your clinician should talk through these risks with you before prescribing it.
- Timing: Start 2–3 weeks before travel. Continue for 4 weeks after returning. This means a longer overall course than Malarone.
Chloroquine and Proguanil
- Now rarely used. Many areas have P. falciparum that resists these drugs.
- Only useful in a small number of destinations with pure P. vivax malaria and no chloroquine resistance.
- Always check current guidance from NaTHNaC and UKHSA for your specific destination.
The ABCD of Malaria Prevention
- A – Awareness: Know your risk. This depends on where you’re going, the season, and your route.
- B – Bite prevention:
- Use DEET insect repellent.
- Wear long sleeves and trousers from dusk onwards.
- Sleep under a bed net.
- Stay in screened accommodation where possible.
- C – Chemoprophylaxis: Take the right antimalarial tablet for your destination and your own health needs.
- D – Diagnosis: See a doctor straight away if you get a fever. This applies during your trip, or up to 12 months after you return from a malaria risk area.
Key Takeaways
- No antimalarial tablet gives 100% protection.
- Avoiding bites is just as important as taking tablets. It is not optional.
- If you get a fever within 12 months of returning from a malaria risk area, get medical help urgently. This applies even if you took antimalarial tablets correctly.
Frequently Asked Questions
No. Malaria risk varies by country and even by region within a country. Some destinations require antimalarial tablets, while others only recommend mosquito bite prevention. A travel health consultation can help determine the most appropriate protection for your itinerary.
The timing depends on the type of antimalarial medication prescribed. Some tablets should be started one or two days before travel, while others need to begin one to three weeks before departure. Always follow the advice provided by your healthcare professional.
Yes. No antimalarial medication provides 100% protection. Travellers should also prevent mosquito bites by using insect repellent, sleeping under insecticide-treated mosquito nets where appropriate, and wearing long sleeves and trousers, especially from dusk until dawn.
This article is for general information only. It is not personal medical advice. Choosing the right antimalarial depends on your own trip, health history, and current medicines. Please book a travel consultation at Priory Pharmacy in York.