malaria prophylaxis and last minute travelling

Last edited 12/2019

Last minute travellers

Last minute visits to malarious regions, whether for vacation, business or family reasons, are now commonplace. This may leave the traveller little time to seek and act on travel advice

• Maloff Protect, a brand of atovaquone plus proguanil combination preparation is available to purchase from pharmacies, whereas atovaquone plus proguanil was previously only available on prescription. Maloff Protect is available for adults aged over 18 weighing 40 kg and above
• retail pharmacy outlets can also supply over-the-counter antimalarials (chloroquine and/or proguanil) though they are now less often used, as well as antimosquito products.

Mefloquine and doxycycline and for those less than 18 years old atovaquone-proguanil combination preparation, are currently prescription-only medicines (POMs), but some pharmacists are now prescribers and thus able to prescribe these POMs. Some retail pharmacy outlets also supply these POMs under PGDs. If the traveller cannot obtain a GP appointment at short notice, some commercial travel clinics cater for walk-in attendees.

Doxycycline or atovaquone-proguanil combination preparation should be started 2 days before travel to a malarious area. Chloroquine or proguanil or chloroquine plus proguanil 1 week before, and mefloquine 2-3 weeks before (to ensure tolerance).

Nevertheless, it is better to start chemoprophylaxis late than not to take it at all, as suppressive prophylactics will begin to work by the end of the malaria incubation period.

Where the recommended choice for the region to be visited is mefloquine or doxycycline or atovaquone-proguanil combination preparation, it would be sensible to avoid mefloquine for last-minute prophylaxis as it takes time to reach steady state, and especially if the traveller has not taken and tolerated mefloquine in the past. PHE does not recommend loading doses of any prophylactic antimalarial

Check the respective summary of product characteristics (SPC) before prescribing drugs described.

Reference:

• Public Health England. Guidelines for malaria prevention in travellers from the UK 2019.