TRAVEL HEALTH
Malaria Prevention and Antimalarial Tablets
When antimalarials are needed, why the decision should be individual, and how prescribing works within a travel consultation.
Malaria remains a serious risk in parts of Sub-Saharan Africa, South-East Asia, South Asia, Central and South America, and the Middle East. Prevention should be discussed in the context of destination, type of travel, season, accommodation, duration of stay and the patient’s medical history. Antimalarial tablets are not needed for every trip — many popular destinations carry no malaria risk at all — but when they are relevant, the decision should be individual and clinically guided.
At Basuto, antimalarial prescribing sits within a broader travel clinic consultation that also covers insect-bite avoidance, timing, side effects, and how malaria prevention fits alongside other travel precautions.
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How antimalarial tablets work
Antimalarial tablets do not prevent mosquito bites. They work by killing the malaria parasite at an early stage if it enters the bloodstream, before it can cause clinical illness. For this reason, they must be taken before, during, and after travel to a malaria zone — not just while you are there. The duration of post-travel dosing depends on which medication is prescribed. Missing doses or stopping too early can significantly reduce protection.
Prescribing options
Common antimalarial options
Atovaquone-proguanil (Malarone) is one of the most commonly prescribed antimalarials for short trips. Started 1–2 days before entering the malaria zone and continued for 7 days after leaving. Generally well tolerated. Doxycycline is a cost-effective alternative, started 1–2 days before travel and continued for 4 weeks after leaving. Side effects may include sun sensitivity and gastrointestinal upset.
Mefloquine (Lariam) is taken weekly rather than daily, starting 2–3 weeks before travel. Useful for longer trips but can cause neuropsychiatric side effects in some patients, which is why the earlier start date allows time to assess tolerance before departure.
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Insect-bite prevention matters as much as tablets
No antimalarial tablet is 100% effective. Bite prevention is an essential part of the strategy, not an optional extra. DEET-based repellents (at least 20–50% concentration), long sleeves and trousers in the evening, sleeping under permethrin-treated bed nets, and staying in screened or air-conditioned accommodation all reduce the risk of being bitten. These measures also protect against dengue, Zika and other mosquito-borne diseases for which no prophylactic medication exists.
Do you need them?
When antimalarials are not needed
Many popular travel destinations do not carry malaria risk and do not require antimalarial tablets. Even within countries that have malaria, risk can vary significantly by region, season and altitude. Thailand, for example, has very low malaria risk in its main tourist areas but higher risk in rural border regions. India carries variable risk depending on itinerary. A travel clinic appointment helps determine whether prophylaxis is genuinely needed for your specific trip.
Common questions
How is the right antimalarial tablet decided?
The choice depends on the specific country and region, the time of year, trip duration, your medical history and current medications, and whether you are pregnant or planning pregnancy. There is no single “best” antimalarial — each has a different regimen, side-effect profile and suitability pattern. The GP reviews all of this at the appointment before prescribing.
Do I need antimalarials for every country at risk, or does it vary by region and season?
It varies. Malaria risk within a country can differ by altitude, season, and rural versus urban areas — some regions warrant prophylaxis while others do not. Your GP reviews current destination-specific guidance and your itinerary together rather than applying a country-level rule.
Are antimalarials safe in pregnancy or for children?
Antimalarial choice in pregnancy and in children requires particular care. Not every antimalarial is suitable for both groups, and in some cases the safest advice may be to reconsider travel to high-risk regions. The GP discusses the specific medicine, dose and risk-benefit at the appointment; general guidance is not a substitute for that review.
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