Travel Health

Available treatment options

Choosing the right antimalarial isn't a one-size-fits-all decision. I look at your destination, your medical history, and the length of your trip. Here is how I generally compare the main options:

• Atovaquone/Proguanil (often known by the brand name Malarone) is typically my first-line recommendation for short holidays. You only need to start it one to two days before travel, and crucially, you only continue it for seven days after leaving the risk area. It is generally very well tolerated, though it is often the most expensive option.
• Doxycycline is a very effective, broad-spectrum antibiotic that also prevents malaria. It is much more cost-effective for long backpacking trips. However, it requires a longer commitment—you must take it for four weeks after leaving the malaria zone. A major clinical pearl I always warn my patients about: it can cause severe photosensitivity. I have treated patients who suffered blistering sunburns in Southeast Asia because they didn't use high-factor sunscreen while taking this.
• Hydroxychloroquine is an older medication. In my current practice, I rarely prescribe it for malaria prophylaxis because the parasite has developed widespread resistance to it in most parts of the world, particularly in Africa and Asia. However, it still has niche uses for specific regions, like parts of Central America, provided the patient has no contraindications like underlying eye conditions.

What to expect from treatment

When you take antimalarials, you must have realistic expectations. No medication is 100% effective, but they significantly reduce your risk of severe illness. The most common complaint I hear from patients relates to mild gastrointestinal upset.

To mitigate this, I strongly advise taking your daily tablet with your largest meal of the day, ideally with a milky drink. This helps line the stomach and drastically improves absorption, particularly for Atovaquone/Proguanil.

Remember that consistency is everything; missing even one or two doses can leave a gap in your protection, allowing the parasite to take hold.

Self-care and prevention

I cannot stress this enough: the absolute best way to prevent malaria is to not get bitten in the first place. Pills are your second line of defence.

In my clinical experience, patients spend hundreds of pounds on tablets but forget basic bite avoidance. You should use a repellent containing at least 50% DEET on all exposed skin.

Here is a vital tip: apply your sunscreen first, let it sink in for twenty minutes, and then apply the DEET on top. Furthermore, mosquitoes that carry malaria typically bite between dusk and dawn.

Wearing loose, light-coloured, long-sleeved clothing in the evenings, and sleeping under an insecticide-treated mosquito net, are just as vital as the prescription I write for you.