Get the Scoop on Antimalarial Medications

🌍 Understanding Antimalarial Medications:

As a family medicine physician, I’m often asked about pre-travel medications, especially antimalarials. Today, let’s delve into a quick discussion on these essential medications:

Malaria 101:

Malaria is transmitted by the bite of a female Anopheles mosquito that is infected with the Plasmodium parasites. Malaria causes symptoms like fever, chills, and flu-like illness. Without treatment, it can lead to severe complications and even death. The risk of contracting malaria varies significantly across different continents and even within countries, emphasizing the need for tailored preventive measures.

Resistance to antimalarial drugs is also a growing concern, making it essential to choose the correct prophylactic medication based on your destination.

1️⃣ Types of Antimalarials:
– Chloroquine (take weekly)
– Mefloquine (take weekly)
– Atovaquone/Proguanil (Malarone) (take daily)
– Doxycycline (take daily)

2️⃣ Choosing the Right One:
– Consider destination (some work better in certain destinations)
– Individual health factors (some interact with certain meds or medical conditions)
– Possible side effects (everyone is different)

3️⃣ Timing Matters:
– Start before travel (all of them)
– Continue after return (all of them)
– Adherence is key (some require daily dosing & some weekly dosing)

🌍 Now, let’s review the pros and cons of each medication:

Chloroquine:

Pros:

* Some people prefer taking their meds weekly

* Good for longer trips because you only take it weekly

* If you are already on hydroychloroquine for a rheumatological condition, you don’t have to take a different medication for malaria prevention (unless there’s resistance to chloroquine where you’re going)

*Can be used during pregnancy

Cons:

* There is a high level of resistance to the med in much of the world (it’s only effective in parts of Central America and the Caribbean)

* Some people prefer not to take a weekly med because they may forget to take it

* Not good for short trips because it has to be taken for 4 weeks after the trip ends

* Not good for last minute travel because med must be started 1-2 weeks before travel

* May make psoriasis worse

Mefloquine:

Pros:

* Some people prefer taking their meds weekly

* Good for longer trips because you only take it weekly

* Can be used during pregnancy

Cons:

* There is resistance to the med in certain parts of the world (Southeast Asia)

* Some people prefer not to take a weekly med because they may forget to take it

* Not good for short trips because it has to be taken for 4 weeks after the trip ends

* Not good for last minute travel because med must be started 2 weeks before travel

* Cannot be used in patients with certain psychiatric conditions

* Cannot be used in patients with a seizure disorder

* Not recommended for patients with cardiac conduction abnormalities

Malarone (Atovaquone/Proguanil):

Pros:

* Low resistance, thus med can be used everywhere

* Good for last minute travel (start 1-2 days before travel)

* Some people prefer to take their meds daily, so they don’t forget to take them

* Good for short trips because you only need to take the med for 1 week after travel ends

* Very few side effects (most people don’t experience any)

Cons:

* Cannot be used during pregnancy or when breastfeeding a child < 5 kg (11 lbs)

* Cannot be taken by people with severe kidney disease

* More expensive than the other antimalarials (especially for long trips)

* Some people prefer not to take a daily medication

Doxycycline:

Pros:

* Good for last minute travel (start 1-2 days before travel)

* Some people prefer to take their meds daily, so they don’t forget to take them

* Least expensive of the antimalarial meds

* If you are already on doxy for acne, you don’t have to take a different medication for malaria prevention (unless there’s resistance to doxy where you’re going)

* It can prevent other infections (ex Rickettsiae and leptospirosis), so it may be preferred by people who plan to do a lot of hiking, camping, and/or swimming in fresh water

Cons:

* Cannot be used during pregnancy or in children < 8 years old

* Some people prefer not to take a daily medication

* Not good for short trips because it has to be taken for 4 weeks after the trip ends (however, you only need to start it 1-2 days before trip)

* Not good for women who are prone to vaginal yeast infections when taking antibiotics

* Not good for trips involving considerable sun exposure because the risk of sun burn is high with this med

* Can cause upset stomach

If you want more in depth information about antimalarial medications, visit the CDC (Centers for Disease Control) website.

Remember, each traveler is unique, and it’s crucial to tailor recommendations based on individual health and trip details. Go to TravelMeds2Go for all your pre-travel meds. Travel safely, stay informed!