Malaria Tablets and Prevention Advice

Antimalarial tablets for travel are not provided on the NHS. Most GP practices will not prescribe or advise on travel malaria prophylaxis. Private travel clinics are the standard route for malaria prevention advice and prescription in the UK. Our clinicians assess your specific destination risk and prescribe the appropriate antimalarial at the same appointment.

Some travel vaccines are available on the NHS at no cost, including hepatitis A in certain circumstances, typhoid, cholera and polio boosters. However, the majority of travel vaccines, including yellow fever, rabies, Japanese encephalitis, hepatitis B and tick-borne encephalitis, are not routinely provided on the NHS and must be accessed privately. Your NHS GP may also have a long wait for travel appointments during peak summer months.

Again, this depends on the tablet. Continue atovaquone/proguanil for seven days after leaving the endemic area. Continue doxycycline and mefloquine for four weeks after return. This post-travel course is essential, as malaria parasites can remain in the body for some time after an infected bite. Stopping tablets early is a common reason returning travellers develop malaria.

Yes. Any immunity to malaria that develops from repeated exposure in childhood is partial, species-specific and wanes significantly within months of leaving an endemic area. Those who grew up in endemic regions and have since lived in the UK are at real risk if they return without prophylaxis. Visiting friends and relatives (VFR travellers) are among the highest-risk groups in travel medicine. Previous exposure does not provide reliable protection.

Side effects vary by medication. Atovaquone/proguanil is generally well tolerated; the most common side effects are mild gastrointestinal symptoms. Doxycycline commonly causes photosensitivity (increased susceptibility to sunburn) and can cause nausea and oesophageal irritation if you don't take it with food and water. Mefloquine carries a risk of neuropsychiatric side effects in some people, including vivid or disturbing dreams, sleep disturbance, anxiety, dizziness and mood changes. If you experience significant side effects on any antimalarial, contact your prescribing clinician before stopping the medication.

Seek urgent medical attention. Tell the doctor or emergency department that you have been to a malaria-endemic area. Malaria can cause fever at any point up to a year after return, and P. falciparum infection can deteriorate rapidly if untreated. Do not wait to see if a fever resolves on its own if you have been in an endemic region. Malaria is a medical emergency.

Yes, in specific circumstances. Mefloquine is no longer a first-line antimalarial for most travellers because of its potential neuropsychiatric side effects, but it remains appropriate in some situations, including when other antimalarials are contraindicated and for certain high-risk destinations. It requires a thorough pre-prescription screening for contraindications, including personal or family history of psychiatric conditions, epilepsy and cardiac conduction abnormalities. Your clinician will determine whether mefloquine is appropriate for you.

There is no single answer. The choice depends on your destination country and the specific region you are visiting, the duration of your trip, your age, your medical history and any existing medications. Atovaquone/proguanil (Malarone) and doxycycline are the most widely used for sub-Saharan Africa and Southeast Asia. Mefloquine is used in some circumstances but requires careful individual assessment. Your clinician will make a specific recommendation for your itinerary.

This depends on which tablet is prescribed. Start atovaquone/proguanil and doxycycline one to two days before entering a malaria-endemic area. Start mefloquine two to three weeks before travel to allow time to identify any side effects before departure. Starting too late reduces the protection tablets can offer in the early days of travel.

This requires individual clinical assessment. Malaria itself is particularly dangerous in pregnancy, carrying serious risks to both mother and foetus, so avoiding travel to high-risk malaria destinations during pregnancy is generally advised where possible. Doxycycline and atovaquone/proguanil are generally contraindicated in pregnancy. Mefloquine may be considered in the second and third trimesters in some circumstances for high-risk destinations. Chloroquine with proguanil is sometimes used in areas with chloroquine-sensitive malaria. Your clinician will assess the risk for your specific destination and advise on the safest option.

No. Even when taken correctly, antimalarial tablets reduce but do not eliminate the risk of malaria. Atovaquone/proguanil and doxycycline offer high levels of protection against P. falciparum when taken as directed, but bite prevention remains essential alongside any medication. No combination of tablets and bite avoidance can guarantee complete malaria prevention.

Yes, with appropriate prescribing. Atovaquone/proguanil is licensed for children weighing 11kg and above, and doxycycline for children aged twelve and over. Mefloquine can be used in children over 5kg in some circumstances. The choice depends on the child’s age, weight and destination. Children are at high risk of severe malaria and should not travel to high-risk endemic areas without appropriate prophylaxis.

Some antimalarials, including doxycycline, can be obtained from online pharmacies in the UK. However, purchasing without a destination-specific risk assessment risks taking the wrong medication for your itinerary or missing contraindications relevant to your health. A brief online consultation that does not cover your full itinerary, region-specific risk or medical history cannot provide the same level of safety as a travel medicine appointment. We strongly recommend a proper consultation before any antimalarial prescription.