Antimalarial Prophylaxis is a medication that is used both as a preventative medicine and as a treatment for malaria. If you are travelling to parts of the world where malaria is a risk factor then antimalarials are an essential consideration. Some countries and regions have developed varying degrees of resistance to some, so not all prophylaxis will be recommended for all areas. It is essential you speak to your GP or nurse practitioner who will be able to use your medical history and clinical judgement to determine which drug is right for you as an individual.
It’s very important to take the correct type of antimalarial as well as the correct dose and finish the course of antimalarial treatment. If you’re unsure, ask your GP, nurse or pharmacist for advice.
Taking Antimalarial Tablets.
- It is important you visit a travel clinic at least a couple of months before you travel to discuss all your options with a qualified professional.
- Start your course of antimalarials as advised by your travel health professional, this is usually for a period of up to 3 weeks before you leave.
- Take the tablets regularly and as directed.
- The incubation period of the disease can vary and can last even after you have gotten home from your trip so it is extremely important to continue taking tablets as directed after you have returned.
- If you are pregnant, or become pregnant during your travels and are on antimalarials, please seek medical advise immediately as they may not be suitable for you.
Types of antimalarial tablets.
These are the antimalarials most commonly recommended for use in the UK.
Atovaquone plus Proguanil (also known as Malarone).
This is a common and popular anti malarial due to the fact that it has relatively few and mild side effects compared to others.
Possible side effects include headaches, mouth ulcers, rash and sometimes intestinal upset. It is not recommended for pregnant women during the first trimester, women who are breastfeeding or those with kidney problems.
The adult dose is one tablet taken once a day every day you are travelling, and the child dose is also once a day but at a lesser strength dependent on the childs weight. It should be started two days before you travel and taken for a week after you return, and is recommended for periods of 28 days but can be used for up to a year. It is also relatively expensive compared to other anti malarial tablets so may be useful on shorter trips.
Mefloquine (also known as Lariam).
This is a tablet that is taken as a 250 mg tablet once a week. The child dosage is again the same frequency but dependent on weight. It should be started three weeks before you travel, taken throughout travel through an at risk area and four weeks after you get back.
Serious side effects are rare, but do include depression, anxiety, psychosis and seizures, insomnia, panic attacks and hallucinations amongst others, an it is not recommended for anyone with a past medical history of heart or liver problems, epilepsy, seizures, depression or other mental health issues. Mefloquine has gained quite a bad reputation because of these side effects, but the benefits of taking the anti malarial outweigh the risks for many who are not subsceptible to them. Many people take this medication quite safely, but the side effects if you are susceptible to them are severe, so it is strongly recommended that you do a three week trial at least two months before you travel to test if you develop any side effects.
Doxycycline (also known as Vibramycin D).
This is a 100mg capsule taken daily. You should start the course two days before you travel, every day you are travelling and for a month after you return.
This is one of the most popular antimalarials because it is relatively cheap compared to other anti malarial tablets and the side effects – for those that do get them, not everyone will – are not as severe as others.
It can cause increased susceptibility to sunburn in some people, as well as heartburn, stomach upset and thrush, and is not recommended for pregnant women or children under 12 at all. It is also not recommended for those who are allergic to tetracycline antibiotics or those with liver problems.It can also reduce the effectiveness of combined hormone contraceptives such as the pill.
Chloraquine And Proguanil.
This combination of antimalarials are rarely recommended because they are largely ineffective against the most common and dangerous type of malaria parasite, Plasmodium falciparum. They are sometimes recommended for destinations where this parasite is not as common such as India or Sri Lanka.
The normal dose is 2 tablets once a week, started one week before you leave, throughout your trip and for 4 weeks afterwards.
There are a wide variety of potential side effects which may include nausea, diarrhoea, headache, rashes, skin itch, blurred vision, hair loss, dizziness, mood change, sun sensitivity or seizures. Those with kidney or liver disease should be assessed carefully before taking this medication and it is normally not recommended for long term use.
Stand By Emergency Treatment (SBET).
This is not common for the average traveller but can be prescribed to those in certain at risk groups such as volunteers, medics working in relief areas or those working in remote areas where there is little or remote access to medical facilities but the risk of malaria is high. If you are in one of these at risk groups then your GP or practice nurse will discuss these options with you.
Examples of emergency standby medications include:
- Atovaquone with Proguanil
- Artemether with Lumefantrine
- Quinine plus Doxycycline
- Quinine plus Clindamycin.
This medication will be given on top of your preventative antimalarials and are not a replacement for them. They are to be taken if you start to develop symptoms of malaria up to a week after being in a malarial area and cannot get to a medical facility. You should still seek medical assistance as soon as possible.
Your SBET medication will be prescribed specifically for you as an individual and are not suitable for anyone else, likewise you should not take mediction prescribed for someone else. Your GP or nurse will discuss the specifics with you based on your individual needs.
Have you read all the information but still need a little more specific advice? Is there a travel health issue that you are worried about and need a little reassurance on? Need some information on malaria, or which vaccinations you will need? Is there a travel health issue you would like to ask about in complete confidence?
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