Malaria medication: take it or leave it?

Posted on 13 February 2015

Antimalarial drugs need to be combined with other protective measures, so is it necessary to take the meds at all? We asked frequent travellers and doctors for their thoughts.

Many products claim to prevent malaria but only the chemo-prophylaxes have been scientifically proven to fight malaria. Those who travel to malaria areas often, though, may be reluctant to take them continuously as prolonged use can cause nausea.

Former Getaway editor Don Pinnock travels so often, he says, he’d end up taking pills permanently, so he chooses not to. Bear in mind, though, as a regular traveller to remote areas he knows the symptoms and how to react: he carries Coartem (a combination drug containing an artemesinin derivation), which treats acute uncomplicated malaria infections. It’s important to know how to use the treatment kit properly.

Travel writer Sihle Khumalo has been to more than 20 countries in Africa, most of them high-risk malaria areas. For his first major trip, he took a prophylaxis as prescribed by a doctor. However, he says, these days he goes away too often, so he skips the meds and takes other precautions (such as insect repellents).

Frequent traveller and writer Victor Dlamini also simply uses preventative measures, he says. Using the antimalarial medication made him ill.

Anaesthetist Martinique Stilwell has another take. Having both suffered from malaria and witnessed patients in hospital dying from cerebral malaria, it’s not a disease she takes lightly. ‘When my daughters were young, I avoided malarial areas. When they were six we ventured forth, with plenty of mosquito repellent, insecticide impregnated nets and medical prophylaxis. At first we took mefloquine (Lariam) but it made us all miserable. Now, depending on the resistance pattern of the area, we take atovaquone/proguanil (Malanil or Malarone), a daily drug that’s expensive but has few side effects.’

Dr Albie de Frey of The Travel Doctor follows three steps: don’t get bitten, seek early treatment, take prophylaxes. He always advises people to take prophylaxes but agrees there are times when it might not be necessary, for example if you’re in a city for two days and spend most of the time in an air-conditioned room. However, he says you should still use a repellent.

Myths busted

True or false?

Prophylaxis makes malaria undetectable.
Although it’s supposed to kill the parasites as they leave the liver, most labs can still detect the disease in the blood. If you tested negative and still feel ill, go for another examination. ‘Keep on testing,’ says Dr Frey, ‘until you’re sure!’


Preventative measures

  1. Wear long-sleeved shirts and long pants at night and early mornings (when mosquitos are most active)
  2. Use good insect repellents such as Tabard, Vital Protection and Peaceful Sleep
  3. Use mosquito nets, and direct a fan at the bed if possible
  4. Spray the sleeping area with repellant before bedtime


The final analysis

Always consult a travel health professional and make your decision based on their recommendations. You’re not likely to find a practitioner who will advise against prophylaxis, but once they’ve taken into consideration your medical history, the area you’re visiting and the activities you’re doing, they may be able to give you alternatives or other practical advice.

This article first appeared in the December 2014 issue of Getaway magazine.

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