ANTIMALARIAL DRUGS
Below are the recommended drugs for travellers from the UK, which are
mentioned within the individual countries within the Travel Clinic.
Chloroquine
Proguanil
Chloroquine plus proguanil
Mefloquine
Maloprim plus chloroquine
Doxycycline
Emergency treatment
Please note: The advice given here reflects the current view in the
UK. The information given is for guidance only. For complete prescribing
information you should read the data sheet supplied with the drugs.
- Other drug regimes may be advocated in other countries and a certain number
of the drugs mentioned may not be available. You are advised to seek
professional advice.
- Different drug regimes are used for different areas of the world. This
reflects differing patterns of drug resistance. We are unable to offer precise
geographical information on these pages and you are advised to seek
professional advice. In the UK travellers can obtain the latest advice for
their journey by checking the UKHealthNet Travel Clinic, asking their GP or visiting a
commercial Travel Clinic.
- No antimalarial drugs are 100% effective. The World Health Organisation
(WHO), in their publication "International Travel and Health" , state
that: "All travellers should be told that protection from biting
mosquitoes is their first line of defence against malaria".
- Compliance with the prescribed regime is essential. Most deaths occur to
those who do not comply fully.
- Antimalarial drugs should be taken for 4 weeks after leaving the last
malarious area of your journey. This will prevent the great majority of
infections.
- Antimalarials are best taken after meals as this will minimise minor side
effects.
Chloroquine is the antimalarial drug of choice for travellers to malarious
areas where there is no resistance to chloroquine. You should start taking
chloroquine one week before entering the malarious area, continue during your
stay and continue for 4 weeks after leaving.
UK trade names
Avloclor,
Nivaquine
Dose (adults)
300mg of chloroquine base weekly. In the UK chloroquine is supplied as tablets
containing 150mg of base so two tablets are taken weekly.
Common side effects
Chloroquine commonly causes minor symptoms of gastrointestinal upset usually on
the day the drug is taken. These can be minimised by taking the drug after the
last meal at night. Chloroquine sometimes causes headaches and may cause
itching (particularly in dark skinned people). Occasionally the drug causes
hair loss which is reversible and may cause temporary blurring of vision (often
on the day after taking the drug).
Who should double check with their GP? Chloroquine
should not be used by people who have epilepsy if they have had a seizure
within the last 2 years or are taking anti-epileptic drugs. Chloroquine may
worsen psoriasis. A reduced dose may be needed in people with renal failure.
Proguanil may be used as an alternative to chloroquine in malarious areas
where there is no resistance to chloroquine. You should start taking proguanil
one week before entering the malarious area, continue during your stay and
continue for 4 weeks after leaving.
UK trade names
Paludrine
Dose (adults) 200mg of proguanil should be taken daily. In the UK
proguanil is supplied as 100mg tablets so two tablets are taken daily.
Common side effects
Mild gastrointestinal upset may occur. The drug may cause mouth ulcers but this
is more common when it is taken in combination with chloroquine (see below).
Who should double check with their GP?
The dose of the drug may need to be reduced in severe renal failure. Proguanil
may affect the dose of anticoagulants needed for those on long term treatment.
Proguanil is safe in pregnancy but a folate supplement should be used.
This combination is used to provide protection in areas where there is
limited to moderate chloroquine resistant malaria. You should start taking
chloroquine and proguanil one week before entering the malarious area, continue
during your stay and continue for 4 weeks after leaving.
UK trade names
Chloroquine - Avloclor, Nivaquine
Proguanil - Paludrine
Dose (adults)
300mg of chloroquine base should be taken weekly plus 200mg of proguanil should
be taken daily. In the UK this means taking two tablets of chloroquine weekly
and two tablets of proguanil daily.
Common side effects
See Chloroquine and Proguanil
individual side effects. Mouth ulcers are more common with this combination
than when proguanil is taken alone.
Who should double check with their GP?
See Chloroquine and Proguanil for
individual contraindications.
Mefloquine is the preferred antimalarial for those at high risk of highly
chloroquine resistant malaria. You should start taking mefloquine at least one
week (ideally two or three weeks) before entering the malarious area, continue
during your stay and continue for 4 weeks after leaving.
UK trade names
Lariam
Dose (adults)
250mg of mefloquine taken weekly. In the UK this equates to one tablet of
mefloquine weekly.
Common side effects
Mefloquine is a prescription only drug and is not suitable for everybody. Its
use should be discussed with your travel health adviser. A recent study by The
London School of Hygiene and Tropical Medicine, published in the British
Medical Journal (BMJ) shows that about 1 in 140 people taking mefloquine will
experience temporarily disabling neuropsychiatric side effects. A previous
study showed that very serious side effects can be expected in 1 in 10,000
people taking this drug. Most people who get side effects will develop them
after the first few doses. Some doctors will advise you to start taking
mefloquine 2 or 3 weeks before you are due to leave, so that if you develop
early side effects an alternative can be found. For most countries (but not
all) where mefloquine is advised a suitable alternative is a combination of
chloroquine and proguanil . This combination will
provide considerable protection against malaria although it may not be quite as
protective as mefloquine. The most common side effects with mefloquine include
dizziness, headache, gastrointestinal disturbances and sleep disorders.
Who should double check with their GP?
It is particularly important to discuss the use of mefloquine with your GP if:
- You have had fits or seizures in the past or any member of your immediate
family suffers from fits or seizures.
- You have a history of psychiatric illness. Depression should be included as
a psychiatric illness but only if it was bad enough to require treatment.
- You are in the first 3 months of pregnancy or you are planning to become
pregnant within 3 months of stopping mefloquine.
- You will be undertaking activities which require precision (for example
piloting a plane, scuba diving etc.) as mefloquine can cause dizziness.
This combination is used as an alternative to mefloquine for travellers to
malarious areas in Australasia and Oceania. You should start taking Maloprim
plus chloroquine one week before entering the malarious area, continue during
your stay and continue for 4 weeks after leaving.
UK trade names
Maloprim - Maloprim
Chloroquine - Avloclor, Nivaquine
Dose (adults)
One tablet of Maloprim and two tablets of chloroquine should be taken weekly.
Common side effects
For chloroquine . If taken at the correct dose, side
effects from Maloprim are rare. It is important that no more than one tablet
weekly is taken as higher doses may lead to bone marrow depression.
Who should double check with their GP?
For chloroquine . Maloprim should not be used by
people with an allergy to sulpha drugs. Maloprim may be used in pregnancy but a
folate supplement should be given.
Doxycycline is generally reserved for travellers going to areas where there
is significant resistance to the other commonly used antimalarials. At present
this would include the border areas of Thailand with Cambodia and Burma.
Doxycycline is a useful alternative for those who cannot take other
antimalarials. You should start taking doxycycline a couple of days before
entering the malarious area, continue during your stay and continue for 4 weeks
after leaving.
UK trade names
Vibramycin
Dose (adults)
100mg taken once daily.
Common side effects
If the contents of the capsule come into contact with the oesophagus (the tube
from the mouth to the stomach) they may irritate it leading to unpleasant
"heartburn" symptoms. To prevent this it is important to wash down
the capsule with plenty of water. It is also wise not to lie down immediately
after taking the drug (to avoid reflux). As doxycycline is an antibiotic it may
cause diarrhoea (paradoxically it will treat many causes of travellers
diarrhoea) and may increase the incidence of vaginal thrush especially in those
prone to this problem. Rarely, doxycycline may sensitise the skin to the sun
leading to an unpleasant rash. It is wise to use efficient sun protection
screens.
Who should double check with their GP?
Pregnant women and children under 12 years of age should not take this drug.
If you are travelling to a malarious area for more than one week and you
may be more than 24 hours from medical attention you should consider carrying a
standby treatment kit. If your journey is for less than one week there is no
need to take standby treatment with you as the incubation period for malaria is
at least one week.
When to use it
If you have been in a malarious area for at least one week and you develop a
temperature of 38°C or more (use a thermometer) you should seek immediate
medical attention. If you are unable to reach medical attention that day and
your condition is deteriorating you should assume you have malaria and
self-treat without delay. Self-treatment should be considered to be a first-aid
measure only and you should still endeavour to get to medical attention.
Suitable standby kit (adult)
For malarious areas with no chloroquine resistance. Treat with 3 tablets of
Fansidar as a single dose and seek medical attention.
For malarious areas with chloroquine resistance. Treat with 600mg of quinine
sulphate taken three times daily for three days followed by a single dose of 3
tablets of Fansidar after the course of quinine is finished.
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