Antimalarials are used to prevent and treat cases of malaria. They are available in various forms and often on prescription only.
- Prevent malaria.
- Available in various forms.
- Getting the right dosage is key.
If you have any concerns about malaria, you can speak with one of our registered clinicians via our online video consultation service. Our clinicians are available for appointments from 9.30am-4.30pm, Monday to Friday.
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What are antimalarials?
Antimalarials are treatments given to prevent or treat cases of malaria. It’s highly recommended that you take antimalarial drugs before arriving in an area where the disease is prevalent, as the risks of developing it can be high. Antimalarials are thought to prevent infections 90% of the time, although they carry risks and some side effects.
What is malaria?
Malaria is a disease that is particularly prevalent in certain tropical regions of the world. It can be fatal, although prompt treatment is highly effective at controlling the infection.
It’s caused by mosquito bites, and spread by people that carry the plasmodium parasite, of which there are five. These are falciparium (the most serious malaria infection, which is common in Africa), vivax (found in Asia and South America), malariae (quite rare and only found in Africa), ovale (in West Africa) and knowlesi (very rare and only found in parts of South East Asia). It can be transmitted to humans in one single mosquito bite.
What symptoms does malaria cause?
Symptoms of malaria usually start within a week to 18 days, although in some cases it may take up to a year before they develop. The first symptoms are flu-like; someone may experience a temperature of above 38°C, shivering, vomiting, headaches, muscle pains and diarrhoea. In some cases, symptoms can be quite mild and make the condition more difficult to diagnose.
Indications of malaria tend to present in cycles, with six to 12 hours of shivering followed by a fever 48 hours later, and so on. If you notice any of these symptoms, you should seek immediate medical attention as infections can quickly result in serious outcomes such as organ failure or difficulty breathing.
How is malaria diagnosed?
Diagnosis requires a simple blood test, the results of which can be received on the same day, so treatment can begin as quickly as possible. Antimalarials will then be prescribed to clear the infection, although it should be noted that if you have taken an antimalarial drug to prevent the infection and it has failed, another one will need to be administered.
Which treatment you receive will depend on where you caught the disease, its severity, the type of malaria you have, your age and whether or not you are pregnant. As some strains have become antibiotic resistant, you may be given a combination of these drugs to ensure that the infection is properly treated.
How is malaria treated?
The best treatment for malaria is prevention; antimalarials are 90% effective at stopping the infection from occurring in the first place. Which type of antimalarial you receive for prevention will depend on a number of factors, such as where you are travelling, your medical history, family medical history, your age, whether you are pregnant and any medications you are currently taking. In some cases, a short trial treatment will be offered to see if you have any adverse side effects with the preferred medication.
Some common sense practices may also greatly reduce the risk of infection, such as using insect repellent, erecting mosquito nets while sleeping, screening doors and windows, using air conditioning and wearing loose fitting clothing, including long sleeves (particularly in the evening).
If you would like to discuss malaria with a doctor, our GMC-registered clinicians are available from 9.30am-4.30pm via our online video consultation service. They can also provide fit notes and referral to specialists for treatment, where appropriate.
What types of antimalarials are available?
There are four common antimalarial treatments available in the UK, each with their own advantages and disadvantages.
Atovaquone and proguanil, which are used in combination, is one of the more expensive treatments and is therefore often only suitable for short trips. It should be taken a few days before your trip and for seven days after your return.
Doxycycline is also often used as a treatment for acne and is one of the cheaper antimalarials. Treatment should begin a few days before your trip and be continued for one month afterwards.
Mefloquine, also known as Lariam, requires a three-week trial period before it’s used as a preventative measure. This is due to some risks associated with the medication, such as for epilepsy or depression. It should be taken for three weeks before your trip and continued for a month after it.
Chloroquine or proguanil are rarely used these days as they are not effective at treating the most common or dangerous malarial strains. It may still be used, however, in areas where these specific parasites are less common, such as India and Sri Lanka.
What side effects can antimalarials cause?
It depends on the treatment that you use. You should read the patient information leaflet that comes with your medication or ask your prescribing doctor about any side effects, if you are concerned.
The following information relates to atovaquone and proguanil:
If you notice any of the following symptoms you should discontinue use and seek immediate medical attention: Rashes, blisters, wheezing, tightness in the chest or throat, difficulty breathing and swollen eyelids, face, lips or tongue.
Very common side effects (may affect more than 1 in 10 people): Headache, nausea, vomiting), stomach pain and diarrhoea.
Common side effects (may affect up to 1 in 10 people): Dizziness, sleeping problems, insomnia, nightmares, depression, loss of appetite, fever, itchy rashes and coughing. The following may show up in blood test results: anaemia, neutropenia and hyponatraemia.
Uncommon side effects (may affect up to 1 in 100 people): anxiety, palpitations, swelling of the mouth, hair loss and hives. The following may show up in your blood test results: increased amylase.
Rare side effects (may affect up to 1 in 1,000 people): hallucinations.
The following side effects have been reported, but there is not enough data to suggest how frequently they occur: hepatitis, cholestasis, tachycardia, vasculitis, seizures, panic attacks, crying, nightmares, severe mental health problems, indigestion, mouth ulcers, blisters, peeling skin, sensitivity of the skin to sunlight. The following may show up in your blood tests: Pancytopenia.
Warnings and precautions when using antimalarials
It’s important to tell your prescribing doctor about any current treatments or conditions you are taking, or have been taking, before using any antimalarials. The following information relates to atovaquone and proguanil only, so you should ensure that you check the patient information leaflet that comes with your medication, or ask your prescribing doctor if you have any concerns.
Atovaquone and proguanil may be unsuitable for you if you have kidney disease.
The following medications may make atovaquone and proguanil unsuitable to take alongside antimalarials: metoclopramide, tetracycline, rifampicin, rifabutin, efavirenz, highly active protease-inhibitors, warfarin and etoposide.
Is it safe to take antimalarials during pregnancy?
Some antimalarials are not safe to use during pregnancy, so it’s essential that you inform your doctor if you are pregnant, thinking of becoming pregnant or are currently breastfeeding before you start treatment.
Will antimalarials affect my ability to drive?
It’s recommended that you undertake a small trial of the medication in question before you drive. This should allow you to determine whether you experience any side effects that may affect your ability to operate any heavy machinery.
Can you buy antimalarials over the counter?
Only one antimalarial treatment is available to buy over the counter in the UK: chloroquine and proguanil. As previously mentioned, however, it is not effective against the most common or severe strains of the disease, so it is important that you seek the right advice from your prescribing doctor before you travel to make sure you are fully protected.
Can I buy antimalarials online?
Our GPhC-registered clinicians are available for consultation about antimalarials via our online video consultation service. You can book an appointment with them between 9.30am and 4.30pm, Monday to Friday. They are also able to issue referral to specialists for treatment and fit notes, where appropriate.
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