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ALL / Infectious Diseases
Malaria: prophylaxis
Malaria: prophylaxis
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 | Headache Contraindicated in epilepsy Taken weekly | 1 week | 4 weeks |
| Doxycycline | Photosensitivity Oesophagitis | 1 - 2 days | 4 weeks |
| Mefloquine (Lariam) | Dizziness Neuropsychiatric disturbance Contraindicated in epilepsy Taken 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:
- chloroquine can be taken
- proguanil: folate supplementation (5mg od) should be given
- Malarone (atovaquone + proguanil): the BNF advises to avoid these drugs unless essential. If taken then folate supplementation should be given
- mefloquine: caution advised
- doxycycline is contraindicated
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.
- diethyltoluamide (DEET) 20-50% has been shown to repel up to 100% of mosquitoes if used correctly. It can be used in children over 2 months of age*
- doxycycline is only licensed in the UK for children over the age of 12 years
*A BMJ review (BMJ 2015; 350:h99) suggest DEET could also be used in breastfeeding women and pregnant women in their 2nd or 3rd trimester
+PassMedicine Notes
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 _ Headache Contraindicated in epilepsy Taken weekly _ 1 week _ 4 weeks| Doxycycline _ Photosensitivity Oesophagitis _ 1 - 2 days _ 4 weeks| Mefloquine (Lariam) _ Dizziness Neuropsychiatric disturbance Contraindicated in epilepsy Taken 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:- chloroquine can be taken
- proguanil: folate supplementation (5mg od) should be given
- Malarone (atovaquone + proguanil): the BNF advises to avoid these drugs unless essential. If taken then folate supplementation should be given
- mefloquine: caution advised
- doxycycline is contraindicated
- diethyltoluamide (DEET) 20-50% has been shown to repel up to 100% of mosquitoes if used correctly. It can be used in children over 2 months of age*
- doxycycline is only licensed in the UK for children over the age of 12 years
*A BMJ review (BMJ 2015; 350:h99) suggest DEET could also be used in breastfeeding women and pregnant women in their 2nd or 3rd trimester
