Planning a trip abroad is exciting, but for many destinations around the world, preparation goes beyond packing and booking accommodation. If you are travelling to a region where malaria is present, understanding your prevention options before you go is one of the most important steps you can take to protect your health.
Malaria is a serious, potentially life-threatening disease transmitted through the bites of infected mosquitoes. It is entirely preventable with the right precautions, and antimalarial tablets are a key part of that protection for many travellers. But with several different options available, knowing which tablet is most suitable for your trip is not always straightforward.
The right choice depends on a number of factors, including your destination, the length of your trip, your medical history, any medications you are currently taking, and how your body has responded to antimalarials in the past. This guide is here to help you understand the main options, what they involve, and why a consultation with a travel health professional is the most reliable starting point.
If you are based in Pembroke or the surrounding area and would like to discuss your travel health needs, contact us at Mendus Pharmacy or book a consultation with our team today.
Why Malaria Prevention Matters
Malaria is caused by a parasite called Plasmodium, which is transmitted to humans through the bite of infected female Anopheles mosquitoes. Malaria is found in more than 100 countries, particularly in tropical and subtropical regions including sub-Saharan Africa, South Asia, Central and South America, and parts of Southeast Asia and the Pacific.
Symptoms can include:
- High temperature, sweating, and chills
- Headaches and muscle aches
- Fatigue and general feeling of being unwell
- Nausea, vomiting, and diarrhoea
- Symptoms that come and go in cycles
In its more severe forms, malaria can cause serious complications affecting the brain, kidneys, and other organs and can be fatal if left untreated. The NHS advises that travellers to malaria-risk areas should take antimalarial tablets as prescribed and continue to use mosquito bite prevention measures throughout their trip.
The Main Antimalarial Tablet Options
There are four antimalarial medicines commonly prescribed to travellers in the UK. Each works differently, suits different destinations and travel types, and comes with its own set of considerations.
| Medicine | How Taken | When to Start | When to Stop | Suitable For |
|---|---|---|---|---|
| Atovaquone/Proguanil (Malarone) | Once daily with food | 1 to 2 days before travel | 7 days after leaving the malaria area | Most malaria regions; short trips |
| Doxycycline | Once daily with food or milk | 1 to 2 days before travel | 4 weeks after leaving the malaria area | Most malaria regions; often used where resistance is present |
| Mefloquine (Lariam) | Once weekly | 2 to 3 weeks before travel | 4 weeks after leaving the malaria area | Certain destinations; longer trips |
| Chloroquine with Proguanil | Weekly (chloroquine) and daily (proguanil) | 1 week before travel | 4 weeks after leaving the malaria area | Limited use; specific regions only where resistance is low |
Atovaquone/Proguanil (Malarone)
Atovaquone/proguanil, commonly known by the brand name Malarone, is one of the most frequently prescribed antimalarials for UK travellers. It is taken once daily, starting one to two days before you enter a malaria-risk area, and continued for seven days after you leave.
Key points about atovaquone/proguanil:
- Suitable for most malaria-risk destinations, including areas with chloroquine-resistant strains
- Well tolerated by most people, making it a common first choice
- The short post-travel course makes it a convenient option for short or medium-length trips
- Should be taken with food or a milky drink to aid absorption and reduce stomach upset
- Not recommended during pregnancy or for people with severe kidney problems
- Can be more expensive than some alternatives, particularly for longer trips
Doxycycline
Doxycycline is a broad-spectrum antibiotic that also provides effective antimalarial protection. It is taken once daily, starting one to two days before travel and continued for four weeks after leaving the risk area.
Key points about doxycycline:
- Effective in most malaria-risk destinations and suitable where resistance to other medicines is a concern
- Generally more affordable than atovaquone/proguanil, making it a practical option for longer trips
- Can increase sensitivity to sunlight, so sun protection is particularly important
- Must be taken with food or a full glass of water to reduce the risk of oesophageal irritation
- Not suitable for pregnant women or children under 12 years old
- May reduce the effectiveness of some hormonal contraceptives; additional contraception may be advisable
Mefloquine (Lariam)
Mefloquine, known by the brand name Lariam, is a weekly tablet that is started two to three weeks before travel, continued throughout the trip, and taken for four weeks after returning. The extended lead-in time is important because it allows any neuropsychiatric side effects to become apparent before travel begins.
Key points about mefloquine:
- The weekly dosing schedule suits some travellers who prefer not to take a daily tablet
- Effective against malaria in many destinations, including sub-Saharan Africa
- Not suitable for people with a history of epilepsy, depression, anxiety, or certain other psychiatric conditions
- Some people experience neuropsychiatric side effects including vivid dreams, anxiety, or mood changes
- Must be started well in advance of travel to assess tolerability before departure
- Prescribed with caution; a clinician will review your suitability carefully before recommending this option
Chloroquine with Proguanil
This combination was once widely used but is now prescribed less frequently due to the widespread development of chloroquine-resistant malaria in many regions. It is still relevant for certain specific destinations where resistance levels remain low.
Key points about chloroquine with proguanil:
- Now only appropriate for a limited number of destinations where chloroquine resistance is not a significant concern
- Chloroquine is taken once weekly; proguanil is taken once daily
- Long term use can affect the eyes; regular eye checks are recommended for extended courses
- A travel health professional will advise whether this combination is appropriate for your specific destination
How to Choose the Right Antimalarial for Your Trip
There is no single antimalarial that is right for every traveller or every destination. A travel health consultation takes into account all of the relevant factors before making a recommendation. These include:
- Your specific destination and the type of malaria present in that region
- The duration of your trip and the nature of your activities whilst there
- Your current medications and any potential interactions
- Any medical conditions that may affect which medicines are safe for you
- Previous experiences with antimalarials, including any side effects
- Whether you are pregnant, breastfeeding, or travelling with children
- Budget considerations across the duration of the trip
Antimalarial Tablets Are Not the Only Precaution
Tablets alone do not provide complete protection. Bite prevention measures are an essential complement to antimalarial medication and should be followed throughout your stay in a risk area, not just at night.
Recommended precautions include:
- Applying a DEET-based insect repellent to exposed skin, particularly in the evenings and at night
- Wearing long-sleeved clothing and trousers after dusk
- Sleeping under a permethrin-treated mosquito net where air conditioning or screened windows are not available
- Closing windows and doors at dusk or ensuring they are properly screened
- Being aware that mosquitoes that transmit malaria are most active between dusk and dawn
Other Vaccinations You May Need for High-Risk Destinations
Malaria tablets are an important part of travel health preparation, but depending on where you are heading, additional vaccinations may also be recommended. Below is a guide to some of the most common high-risk destinations and the vaccines typically advised alongside antimalarial precautions.
Sub-Saharan Africa (e.g. Kenya, Tanzania, Ghana, Nigeria)
Sub-Saharan Africa carries some of the highest malaria transmission rates in the world. In addition to antimalarial tablets, travellers to this region are commonly advised to consider the following vaccinations:
- Yellow fever — required for entry into some countries and strongly recommended for others; a certificate of vaccination may be needed
- Typhoid — recommended for most travellers, particularly those visiting rural areas or eating local food
- Hepatitis A — recommended for all travellers to the region
- Hepatitis B — recommended if you may have medical treatment, work in healthcare, or have close contact with local populations
- Meningococcal meningitis — recommended particularly for travel to the Meningitis Belt across central Africa
- Rabies — recommended for longer stays, adventurous travel, or work involving animals
- Cholera — considered for travellers working in high-risk settings or areas with poor sanitation
South Asia (e.g. India, Pakistan, Nepal, Bangladesh)
Malaria is present in parts of India, Pakistan, and Bangladesh, though risk varies considerably by region. Travellers to South Asia may also be advised to consider:
- Typhoid — strongly recommended, particularly in India and Pakistan where typhoid fever is prevalent
- Hepatitis A — recommended for all travellers
- Hepatitis B — recommended depending on activities and length of stay
- Japanese encephalitis — recommended for travellers spending extended time in rural areas, particularly during monsoon season
- Rabies — recommended for longer stays or travel in remote areas
- Cholera — considered for those visiting areas with active outbreaks or limited sanitation
- Tetanus, diphtheria, and polio — ensure routine vaccinations are up to date before travel
Southeast Asia (e.g. Thailand, Vietnam, Cambodia, Indonesia)
Malaria risk in Southeast Asia varies significantly between and within countries, and is generally lower in tourist areas. Risk is higher in rural and forested regions. Vaccinations commonly recommended for this region include:
- Hepatitis A — recommended for all travellers
- Hepatitis B — recommended depending on activities and planned length of stay
- Typhoid — recommended particularly if visiting rural areas or eating local street food
- Japanese encephalitis — recommended for rural travel, particularly in rice-growing or agricultural areas
- Rabies — recommended for extended travel or work with animals
- Cholera — considered in areas with poor sanitation or during outbreak periods
- Yellow fever — not endemic but a certificate may be required if arriving from a yellow fever country
Central and South America (e.g. Brazil, Colombia, Peru, Bolivia)
Malaria is present in parts of Central and South America, particularly in the Amazon Basin and rural lowland areas. Many popular tourist destinations have low or no malaria risk, but travellers venturing beyond coastal and urban areas should seek specific advice. Vaccinations commonly recommended include:
- Yellow fever — required for entry into some countries; strongly recommended for jungle and rural travel in endemic areas
- Typhoid — recommended for most travellers, particularly those eating local food or visiting rural areas
- Hepatitis A — recommended for all travellers
- Hepatitis B — recommended depending on planned activities
- Rabies — recommended for jungle or wildlife-focused travel and extended stays
- Cholera — considered in areas with limited sanitation or active outbreaks
- Tetanus, diphtheria, and polio — ensure these are up to date before travelling
West Africa (e.g. Senegal, Cameroon, Côte d’Ivoire, Sierra Leone)
West Africa is considered one of the highest-risk regions for malaria in the world. Antimalarial tablets are strongly recommended for all travellers to this region. Additional vaccinations commonly advised include:
- Yellow fever — mandatory for entry into many West African countries; vaccination is strongly recommended regardless of requirements
- Typhoid — recommended for all travellers
- Hepatitis A — recommended for all travellers
- Hepatitis B — recommended for most travellers
- Meningococcal meningitis — particularly important during the dry season and for the Meningitis Belt countries
- Rabies — recommended for extended travel or animal contact
- Cholera — considered for those in high-risk settings or areas with poor infrastructure
- Polio — check current guidance as transmission status changes; may be required for re-entry to the UK in some circumstances
Find out which vaccines you need here:
Frequently Asked Questions
➤ Do I definitely need malaria tablets for my trip?
Not all destinations carry a malaria risk and not all areas within high-risk countries require antimalarials. A travel health consultation will assess the specific risk for your itinerary and advise accordingly.
➤ How far in advance should I arrange my malaria tablets?
Ideally at least four to six weeks before travel, as some tablets need to be started several weeks before entering a risk area, and a consultation takes time to arrange. Some options, such as atovaquone/proguanil and doxycycline, can be started closer to departure if necessary.
➤ Can I buy malaria tablets over the counter?
Some antimalarials are available without a prescription, but the appropriate choice depends on your individual health and destination. Seeking professional advice before purchasing ensures you receive the most suitable option.
➤ What should I do if I feel unwell after returning from a malaria-risk area?
Seek medical attention promptly and inform your GP or any treating clinician that you have recently travelled to a malaria-risk area. Symptoms can appear weeks after returning, so mention your travel history even if you feel well at first.
➤ Are antimalarials safe to take during pregnancy?
Some antimalarials are not recommended during pregnancy. If you are pregnant or planning to become pregnant and need to travel to a malaria-risk area, seek specialist travel health advice as early as possible.
➤ Can children take antimalarial tablets?
Most antimalarial options are available for children, though doses and suitability vary by age and weight. A clinician will advise on the most appropriate option for a child travelling to a risk area.
➤ Do antimalarial tablets guarantee I will not get malaria?
No antimalarial provides 100% protection. Tablets significantly reduce the risk but should always be combined with bite prevention measures for the most effective protection possible.
Get Expert Travel Health Advice in Pembroke
Travelling safely to a malaria-risk destination takes preparation, and getting the right advice before you go makes a meaningful difference. From choosing the most suitable antimalarial tablets to ensuring your vaccinations are up to date for your specific destination, our team at Mendus Pharmacy in Pembroke is here to help you travel with confidence.
We offer personalised travel health consultations that take your itinerary, health history, and individual circumstances into account, so you leave with a plan that is tailored to you, not just to your destination.
Get in touch with us today or book a travel health consultation with our team at Mendus Pharmacy and make sure you are fully prepared before you travel.