DIFFERENT TYPES OF MALARIA
There are 4 different species of human parasite:

Plasmodium falciparum (most serious) in sub-Sarahan Africa, Papua New Guinea and Amazon rain
forests of South America – death can occur within days

Plasmodium vivax in Indian sub-continent

P.Ovale mostly in Africa

P.Malariae mostly in Africa
The mosquito is responsible for transmitting many diseases, such as dengue fever, yellow fever, Japanese B encephalitis, but
malaria is the most serious of these tropical diseases. The malaria parasite enters your body when the mosquito bites you, and the
parasites first of all go to your liver, where they will stay for many days, and where they multiply over and over again. At this stage
you have no idea you have malaria, as you have no symptoms. The parasites then come out of the liver and invade your red blood
cells, and multiply again. After two or three days they will burst out of the red cells, and this is often when you get the symptoms of
malaria: shivering, sweats and fever, muscle pain and tenderness, headache, and sometimes diarrhoea and a cough. There are
four species of malaria, and one of them, called Plasmodium falciparum, is extremely dangerous. It is possible to die from this type
within 24 hours of developing the symptoms of malaria. Each year in the United Kingdom, we see up to 2,000 cases of malaria in
people who have returned from tropical areas with the disease, and we see on average nine deaths per year. None of these
deaths needed to happen. They usually occur because people have not taken the correct precautions. People living in the United
Kingdom will not have any protection against the malaria parasite, and indeed, people who used to live in a malarious country but
have left there will also not have protection against the disease, as you quickly start to lose your natural immunity within a matter of
months after leaving a malarious zone. So when we advise travellers within a consultation, we focus on malaria advice, with an A,
B, C, D approach. A is for awareness, understanding the risk and seriousness of the disease. B is for bite prevention, because you
significantly reduce your risk of malaria if you minimise the potential to get bitten. C is for the drugs we refer to as
chemoprophylaxis. Making sure that the most appropriate drug is selected, and that the course of tablets is always finished - this is
absolutely essential. And D is for diagnosis: understanding the symptoms of malaria and knowing to seek medical help
immediately. In the medical profession we regard this as a medical emergency.
When people come back from their holiday, and they're back into work, and they're feeling fine, they often decide there's no need
to carry on with their malaria tablets. It is absolutely essential to complete the course of malaria tablets, to help prevent malaria
breaking through.
Remember, malaria presents like a 'flu-like illness. Don't be confused by this. If you get the symptoms, it's essential that you go to
your GP's surgery and say that you have been abroad. You will need a test for malaria.
This will enable a speedy diagnosis and could potentially save your life. Look out for the symptoms of malaria, particularly in the
first three months, but up to a year after your trip, and make sure that you visit the doctor's surgery and let them know that you've
been to a malarious zone. Taken from www.malariahotspots.co.uk Jane Chiodini’s audio transcript. Taken from internet March
2008.
Anti-malarial medication
Your nurse/doctor will advise which tablets you should take.
Medication
How long before
Whilst in the
How long after
entering malarious
malarious area
departing malarious
area?
area?
Chloroquine
Commence 1 week
Every week whilst
4 weeks after
(Adults) 300mg
before entering
in malarious area
departing malarious
to be taken weekly
malarious area
Proguanil
Commence 1wk
Every day whilst in 4 weeks after
(Adults) 200mg
before entering
malarious area
to be taken daily
malarious area
Mefloquine
Commence 2-3
Every week whilst
4 weeks after
(Adults) 250mg
weeks before
in malarious area
departing malarious
area
departing malarious
area
to be taken weekly
entering malarious
area
area
Malarone
Commence 1-2 days
Every day whilst in 7 days after departing
(Adults) x1 tablet
before entering
malarious area
to be taken daily
malarious area
Doxycycline
Commence 1-2 days
Every day whilst in 4 weeks after
(Adults) 100mg
before entering
malarious area
to be taken daily
malarious area
malarious area
departing malarious
area
Please visit: www.malariahotspots.co.uk and make sure you know how to prevent yourself
from getting malaria.
Questions
Atovaquone/Proguanil
Malarone/Malarone Paediatric
Doxycyline
Vibramycin
Mefloquine
Lariam
Chloroquine/Proguanil
Paludrine/Avloclor
How effective is it?
When do I take them?
95-100% effective



What are the key things I should
consider?



Speak to your health care
professional before taking the
antimalarials
Who should not take these
antimalarials?
What are the possible side
effects?


>90% effective
1-2 days before you go
Every day in the malarious
area
7 days when you leave that
area



1-2 days before you go
Every day in the malarious area
28 days when you leave that area



1-3 weeks before you go
Every week in the malarious area
28 days when you leave that area
Take with food or a milky drink
at the same time each day
Repeat dose if you vomit
within 1 hour
Malarone Paediatric is the
only antimalarial specifically
formulated for children

Take with full glass of water after a meal
and stay upright for at least half an hour
May make you more susceptible to
sunburn, use high factor sun cream, if a
skin rash occurs consult your doctor or
practice nurse
May reduce efficacy of combined oral
contraceptive pill/patch, use extra
precautions for 3 weeks
May cause vaginal thrush
Alcohol may decrease the effectiveness
If you have systemic lupus erythematosus
(SLE), porphyria or achlorhydria
If you are taking warfarin, penicillin drugs,
barbiturates, carbamazepine or phenytoin,
methoxyflurance, certain retinoids, digoxin,
lithium or diuretics
Is not suitable for children under 12 years
If you are pregnant or breast feeding
If you are allergic to tetracycline antibiotics
If you have fructose intolerance, glucosegalactose malabsorption, or sucraseisomaltase deficiency

The tablets should be swallowed
whole, preferably after a meal with
plenty of liquid
It is advisable to avoid pregnancy for
3 months after completing the course
If in a malarious area for more
than 4 weeks
If you are taking
metoclopramide, tetracycline,
rifampicin, rifabutin or indinavir


If you weigh less than 11kg
If you are pregnant or breast
feeding unless your doctor
tells you otherwise

Common: (similar to
placebo) headache,
abdominal pain, diarrhoea
Uncommon: fever, nausea,
vomiting, anorexia, cough,
anaemia, insomnia, dizziness,
breathlessness, rash or hair
loss

What is the approximate cost ?
Info taken from BNF Sept. 2009.
NB: Chemists may charge a
dispensing fee and VAT. Always
ensure you get British Standard
drugs to ensure efficacy.
>90% effective
12 Tablet pack = £25.21










Headache, abdominal pain, nausea, vomiting,
anorexia, anaemia, rash, flaking of the skin,
exaggerated sunburn, mouth ulcers, indigestion, loss
of appetite, thrush or soreness and itching of the
genital area, blurred vision, worsening of SLE,
anaphylactic shock, tinnitus, discolouration of teeth
100mg 8 Tablet pack = £1.14



Effective in chloroquine sensitive areas of the world
only

2-7 days before you go

Chloroquine – every week in the
malarious area

Proguanil – every day in the malarious
area

28 days when you leave that area

The exact areas in which you are
travelling to must still be sensitive to
chloroquine

If appropriate, ensure you have the
rabies vaccine before you start taking
chloroquine

If you suffer from heart trouble, high
blood pressure, blood clotting
disorders or diabetes
If you have had an oral vaccine in
the last 3 days




If you weigh less than 5kg
If you are pregnant or breast feeding,
unless your doctor tells you
otherwise; not during the first 3
months of pregnancy

If you have had any mental health
problems or depression

If you have epilepsy

Patients taking Zyban for smoking
cessation

Common: headache, abdominal
pain, diarrhoea, nausea, vomiting,
dizziness, loss of balance, sleep
disorders, abnormal dreams

Uncommon: fever, anorexia,
depression, mood changes, anxiety,
confusion, hallucinations, panic
attacks, restlessness, forgetfulness,
paranoia, convulsions, visual/hearing
impairment, chest pain, palpitations,
rash, hair loss, rare reports of
suicidal tendencies
8 tablet pack = £14.53



The Sheffield University Health Centre take no responsibility for the accuracy of this information.
Should not be used during pregnancy
unless your doctor tells you otherwise
If you are taking hydroxchloroquine
Patients taking Zyban for smoking
cessation
Headache, nausea, vomiting, itching, hair
discolouration or hair loss, convulsions, mood
changes, or other effects on behaviour, changes in
your blood, mouth ulcers, rash and transient eye
problems.
If you take chloroquine for a long time speak to
your health care professional about possible side
effects
Chloroquine: 20 tablet pack = £1.22
Chloroquine plus Proguanil Travel Pack: 14
chloroquine tablets and 98 proguanil tablets +
£8.79
Patient Information Leaflet on Malaria Prophylaxis. January 2009. IT IS IMPORTANT THAT YOU READ THIS CAREFULLY.
Always ensure you ask your Doctor or Nurse for the most up to date advice on taking Anti-Malarial Tablets.
If you have porphyria, epilepsy or
psoriasis
If you take chloroquine for a long time
there are other precautions
If you are taking warfarin