Anti-Malaria Treatment

This service is not suitable for you if you:

• Are under 17 years old
• Are pregnant, planning to become pregnant or breastfeeding
• Have contracted malaria in the last year
• Have severe kidney or liver disease
• Are taking warfarin

Malaria is a very serious infection caused by the parasite Plasmodium. This can enter the bloodstream if you are bitten by a mosquito that is carrying this infection.

This disease is widespread across the tropical and subtropical areas of the world. The symptoms can develop rapidly and without prompt treatment, it can be fatal.

You cannot be vaccinated against malaria.

If you are travelling to a high-risk malaria area, you should be aware of the symptoms of malaria:

• A very high temperature & feeling feverish (hot/ clammy/ shivery)
• Headaches
• Vomiting, diarrhoea, tummy pains
• Muscle aches
• Fatigue
• Coughing
• Shortness of breath
• Sore throat
• Confusion

Symptoms generally occur between one and eight weeks after the initial mosquito bite, however, in some cases they can develop up to a year later.

Certain groups of people are more vulnerable to more severe infection such as pregnant women & children, the elderly and those who are immunocompromised (their immune system is weak).

If you think you have malaria, you need to seek urgent medical advice, wherever you are.

If you have travelled to a malaria area within the previous year, you may be at risk, even if you took anti-malaria medication during this time.

The diagnosis is usually made on your clinical history and a blood test.

Anti-malaria drug treatments should ALWAYS be used along with mosquito bite avoidance measures – see section  ‘What are mosquito avoidance measures?’.

The most common anti-malarial drug treatments used in Ireland are: 

• Vibramycin (doxycycline)
• Malarone (atovaquone/proguanil)

The ’best’ treatment depends on where you intend to travel, how long you intend to stay and your medical history. 

That being said, for various reasons the Malarone (atovaquone/proguanil) medication is the most frequently prescribed. This is because despite the need to take this tablet on a daily basis while in a malaria zone, it must be taken for only another seven days upon exiting the malaria area. In contrast, doxycycline must be taken for a further 28 days upon leaving the malaria zone.

Doxycycline is not recommended if:

• You are pregnant, trying to conceive breastfeeding
• You are allergic to doxycycline medication
• You have significant liver disease
• You have the following conditions:
  • Lupus
  • Myasthenia Gravis
  • Porphyria

Doxycycline can interact with some medications including warfarin, Roaccutane and other antibiotics. It is essential that you let us know what medications you are taking so we can check for any potential interactions.

Common side effects include heartburn/ indigestion, nausea, vomiting, diarrhoea and abdominal pain.

This medication will make you more sensitive to sunlight, and therefore your skin will burn more easily in the sun. You should ensure you have appropriate clothing to cover and protect your skin and high-factor sunscreen.

Women can experience vaginal thrush when taking this, especially for a prolonged time.

If you develop the following symptoms you should stop this medication and seek URGENT medical advice:

• A persistent headache with blurred vision/ loss of vision and nausea/ vomiting
• A significant & persistent skin rash

For full details please read the information leaflet that comes with your medication before you start it.

Start this medication 1-2 days before you enter the high-risk malaria area, continue for the entire duration of your stay and for 28 days after you leave the affected area.

Take 100 mg (one tablet) daily, with a meal/ snack and a full glass of water, and remain in a sitting/ standing position for 60 minutes after.

Avoid calcium, magnesium, aluminium, zinc and iron for 1-2 hours before and after taking this medication as they can affect absorption (this includes vitamin supplements and dairy products).

If you miss a dose, take it as soon as you remember. If it is almost time to take the next dose, then skip the missed dose – you should not take 2 doses together.

Ensure you complete the course.

Malarone is not recommended if:

• You are pregnant, trying to conceive or breastfeeding
• You are allergic to Malarone (atovaquone/ proguanil)
• You have significant kidney disease

Malarone can interact with some medications including warfarin and other antibiotics. It is essential that you let us know what medications you are taking so we can check for any potential interactions.

Malarone (atovaquone/ proguanil) generally is well-tolerated. If side effects do occur they may include headache, dizziness, nausea/ vomiting/ diarrhoea, low mood and skin reactions.

For full details please read the information leaflet that comes with your medication before you start it.

Start this medication 1-2 days before you enter the high-risk malaria area, continue for the entire duration of your stay and for 7 days after you leave the affected area.

Take one tablet at the same time each day with food.

If you miss a dose or have vomiting within one hour of taking it, you should take another tablet as soon as possible and carry on with the schedule.

If you have diarrhoea, continue to take this medicine, but be aware that absorption may be affected and it may not be as effective.

Ensure you complete the course of treatment as instructed.

• Avoid mosquito bites, especially after sunset. If you are out at night wear long-sleeved clothing and long trousers
• Use an insecticide spray (such as Permethrin) on clothes as mosquitoes can bite through thin layers of clothing. AVOID spraying insecticide on the skin!
• Spray pesticides in the room (especially beneath bedside lockers and other bedroom furniture), burning pyrethroid coils, and heating insecticide-coated tablets all help to repel mosquitoes
• Use an insect repellent (ideally one that contains DEET) on areas of skin that are exposed
• If you are staying in a place where there are no insect screens, you should strongly consider keeping the windows closed
• Use a mosquito net while sleeping – hint: spray insecticide on your net to further prevent mosquito bites

Vitamin B, garlic and ultrasound devices DO NOT offer protection against mosquitoes bites.

The drug treatments that we can prescribe via this service are NOT suitable/ safe if you are pregnant, trying to conceive or breastfeeding.

Pregnant women are at increased risk of more severe malaria infections, and where possible are advised not to travel to an area deemed to be high risk for malaria.

If this is something you would like to discuss further, we would advise that you arrange an appointment with your local GP or travel clinic.

• Malaria is a serious and potentially fatal disease. There is no vaccination for malaria
• Not all malaria treatments are suitable for all high-risk malaria areas. Check the Fit For Travel site for specific information on malaria in the area you are travelling to
• Things change – the treatment you used for the same area may not be suitable now. Always seek advice for each new trip
• Anti-malaria drug treatments should ALWAYS be used along with mosquito bite avoidance measures
• If you develop malaria symptoms when travelling, or when you return home, you must seek medical attention urgently, even if you have been taking antimalarial tablets