Anti-Malaria Treatments

Malaria is a serious and sometimes life-threatening illness caused by Plasmodium parasites. It is spread by the bite of an infected female Anopheles mosquito, which feeds mainly between dusk and dawn. A single bite is enough to pass on the infection.

There are five Plasmodium species that infect people. P. falciparum is the most dangerous, while P. vivax and P. ovale can lie dormant in the liver and cause illness much later. Malaria is found in more than 100 countries across sub-Saharan Africa, South and Central America, parts of Asia, the Middle East and the Pacific. It does not occur in the UK, so almost all UK cases are linked to travel.

Malaria is not passed from person to person through everyday contact.

Malaria can be hard to spot because it often starts like a bad bout of flu. Common symptoms include:

• a high temperature, or feeling hot, cold or shivery
• sweats and chills
• headache, and sometimes feeling confused
• feeling very tired or sleepy, which is especially noticeable in children
• feeling and being sick, tummy pain and diarrhoea
• loss of appetite and muscle pains
• yellowing of the eyes or skin (jaundice), which may be harder to see on brown or black skin
• a sore throat, cough or difficulty breathing

Symptoms usually appear 7 to 18 days after being bitten, but they can develop much later, sometimes months or even a year or more after you return home.

For most people, malaria symptoms appear between 7 and 18 days after an infected mosquito bite. The exact timing depends on the type of parasite. Illness caused by P. falciparum, the most serious form, usually develops within 7 to 14 days.

Symptoms can also appear much later. With P. vivax and P. ovale, the parasite can lie dormant in the liver and cause illness months, or occasionally a year or more, after you were bitten. This means malaria can develop long after a trip has ended, even once you feel fully back to normal.

Pharmacist advice: If you develop a fever or flu-like illness up to a year, or longer, after visiting an area where malaria is found, seek medical help urgently and tell the doctor where you have travelled. Do not wait for it to pass. If you are still abroad, get medical advice straight away rather than waiting until you are home.

It is important to separate prevention from treatment.

Preventing malaria can be achieved with antimalarial tablets. The antimalarial tablets available through Pharmica include Malarone, generic Atovaquone/Proguanil and Lariam (mefloquine). These tablets are taken before, during and after travel to greatly reduce your chance of catching malaria. However, they do not offer complete protection, so they should always be combined with bite avoidance.

Treating active malaria is different, and it is a medical emergency. Someone who has caught malaria needs urgent hospital care, often with different medicines and sometimes given directly into a vein. This is why getting a fever checked quickly after travel is important.

Health professionals use a simple ABCD approach to malaria prevention:

• Awareness of risk: check whether malaria is present at your destination, and get travel health advice in good time, ideally 4 to 8 weeks before you go, though it is never too late.
• Bite prevention: use an insect repellent containing up to 50% DEET on exposed skin, cover up with long sleeves and trousers in the evening and at night, and sleep under an insecticide-treated net or in an air-conditioned room. Anopheles mosquitoes bite mainly between dusk and dawn.
• Chemoprophylaxis: take antimalarial tablets exactly as prescribed, starting before you travel, throughout your trip and for the full period after you return. The right tablet depends on your destination.
• Diagnosis: if you feel unwell during or after travel, seek medical help promptly and mention where you have been.

Antimalarial tablets and strict bite avoidance together greatly reduce your risk, but no single measure is fully protective on its own.

Anyone travelling to an area where malaria is found can catch it, but some people are at higher risk of becoming seriously unwell:

• pregnant women
• babies and young children
• adults over 65
• people with a weakened immune system
• people who do not have a working spleen
• travellers visiting friends and relatives in their country of origin, as any immunity from childhood is lost after living in a malaria-free country

If you are in one of these groups, it is especially important to get travel health advice early. You may be advised to take extra care, or in some cases to avoid higher-risk areas.

Whether you need antimalarial tablets depends entirely on where you are travelling. Malaria risk varies enormously between countries, and even between regions and seasons within the same country, so there is no single answer that applies to a destination such as Thailand, India or Kenya. It is worth checking your exact itinerary against up-to-date guidance from the TravelHealthPro (NaTHNaC) website, which gives country-by-country advice, including which tablets are recommended where. When you start a consultation with Pharmica, our prescribing team reviews your travel plans and medical history to confirm whether prophylaxis is needed and which tablet suits your trip.

Two malaria vaccines, RTS,S and R21, have been approved and are being given to young children in parts of Africa where malaria is common, where they help reduce cases and deaths. They are not currently used for travellers from the UK.

If you are travelling, your protection comes from antimalarial tablets taken correctly, together with measures to avoid mosquito bites. No travel vaccine removes the need for these measures.

Timing differs between tablets, so it is worth checking which one you have been prescribed. Malarone and generic Atovaquone/Proguanil are started 1 to 2 days before you enter a malaria area and only need to be continued for 7 days after you leave. Doxycycline is also started 1 to 2 days before travel but must be continued for 4 weeks after your return. Lariam (Mefloquine) needs a longer run-up of 2 to 3 weeks before travel, partly so any side effects can be picked up before you go, and it is also continued for 4 weeks after you leave. Most tablets do not stop the parasite entering your body; they work on it after it emerges from the liver, which can happen weeks after you get home. Stopping early is one of the most common reasons prevention fails, so it is worth setting a reminder to finish the full course even once your holiday feels like a distant memory.

Malarone, generic Atovaquone/Proguanil and Doxycycline are prescription-only medicines in the UK, so they are not available on general pharmacy shelves. At Pharmica, you can complete a short online consultation instead of booking a GP or travel clinic appointment. Our prescribing team reviews your answers and travel plans, confirms which tablet is suitable, and, once approved, your medication is dispensed and delivered directly to you.