There are around 1,500-2,000 cases each year of malaria in patients returning from endemic countries. The majority of these cases (around 75%) are caused by the potentially fatal
Plasmodium falciparum
protozoa. The majority of patients who develop malaria did not take prophylaxis. It should also be remembered that UK citizens who originate from malaria endemic areas quickly lose their innate immunity.
Up-to-date charts with recommended regimes for malarial zones should be consulted prior to prescribing
| Drug | Side-effects + notes | Time to begin before travel | Time to end after travel |
|---|---|---|---|
| Atovaquone + proguanil (Malarone) | GI upset | 1 - 2 days | 7 days |
| Chloroquine | HeadacheContraindicated in epilepsyTaken weekly | 1 week | 4 weeks |
| Doxycycline | PhotosensitivityOesophagitis | 1 - 2 days | 4 weeks |
| Mefloquine (Lariam) | DizzinessNeuropsychiatric disturbanceContraindicated in epilepsyTaken weekly | 2 - 3 weeks | 4 weeks |
| Proguanil (Paludrine) | 1 week | 4 weeks | |
| Proguanil + chloroquine | See above | 1 week | 4 weeks |
Pregnant women should be advised to avoid travelling to regions where malaria is endemic. Diagnosis can also be difficult as parasites may not be detectable in the blood film due to placental sequestration. However, if travel cannot be avoided:
It is again advisable to avoid travel to malaria endemic regions with children if avoidable. However, if travel is essential then children should take malarial prophylaxis as they are more at risk of serious complications.