Medicines for malaria are taken in two cases: prophylactically before travelling to a country where malaria is present, and therapeutically when it is not possible to prevent infection. The malaria prophylaxis replaces the vaccine. The malaria medication, which is taken when symptoms occur, is intended to save the patient's life. Which malaria medication will fight the disease? When are malaria tablets enough and when is hospital treatment necessary? 

Malaria medication – when to administer

Malaria medication is administered in two cases: prophylactically and therapeutically. What may be less obvious is that malaria tablets are used as part of so-called chemoprophylaxis for malaria. In this case, antimalarial drugs are taken by completely healthy people. The pharmacological agents are intended to protect against infection and the development of the disease in the event of a bite by a mosquito infected with malaria.

These malaria tablets therefore act as a de facto vaccine, which is important because a vaccine in the strict sense is not yet available (the first ever malaria vaccination programme will not start until 2018, but the drug being tested as part of the programme will only be given to children in three African countries: Ghana, Kenya and Malawi). The malaria tablets (including proquanil, doxycycline, chloroquine) should be started just before departure and then taken in the same dose throughout the stay in the tropics and for several weeks after return. It is not worth saving on this type of protection, especially since it is not expensive. As for antimalarial drugs, the prices can be as low as a few dozen zlotys.

The second use of malaria drugs is more obvious - it is to save health and life in a situation where infection has not been avoided and the disease develops in the body.

Malaria tablets: ACT therapy

Treatment of the disease usually involves the administration of a combination of malaria drugs, very often one of which is artemisinin or its synthetic derivatives (arthemether, dihydroartemisinin and artesunate), and the other a selected drug from another group. This type of combination therapy is called ACT (Artemisinin-based Combination Therapy) and is widely used in many countries around the world in the fight against malaria. It is worth emphasising that this is an enteral therapy, in which malaria tablets are used, without the need for injections (intravenous agents are reserved for the most severe cases, more on this below).

The Department of Epidemiology and Tropical Medicine in Gdynia, referring to the recommendations of the World Health Organisation (WHO), states that the currently used antimalarial drugs in ACT therapy are:

artemether/lumefantrine

dihydroartemisinin/piperaquine

artesunate/amodiaquine

artesunate/sulfadoxine-pyrimethamine

artesunate + mefloquine

artesunate + doxycycline or clindamycin

atovaquone/proguanil

quinine + doxycycline or clindamycin

chloroquine + primaquine

Malaria medication – how long will the malaria tablets last?

The choice of malaria medication depends on the type of parasite that caused the infection. ACT malaria tablets are generally taken for mild infections caused by less virulent parasites.

If the most common plasmodium (Plasmodium vivax) is the cause of the infection, a combination of chloroquine and primaquine is used. If resistance to chloroquine is detected, the doctor prescribes dihydroartemisinin/piperaquine or artemether/lumefantrine. Infections caused by Plasmodium ovale (Plasmodium ovale) are treated with chloroquine and primaquine, while chloroquine alone is sufficient for Plasmodium malariae) .

Malaria tablets - doxycycline

Doxycycline is a tetracycline antibiotic with a bacteriostatic effect. Doxycycline blocks protein synthesis and increases the effectiveness of the immune system's response. This antibiotic is so versatile that it has dozens of uses, from the treatment of venereal diseases to pneumonia. Most importantly, doxycycline tablets are also effective against malaria. Moreover, doxycycline is recommended to protect against the most dangerous form of malaria, caused by sickle-shaped Plasmodium falciparum.

Doxycycline is sold in 100 mg capsules. The standard pack contains 10 capsules. Even for the shortest trip to the tropics, you should buy several packs. Doxycycline should be started 1-2 days before the trip, then taken daily during the trip and for 28 days after the trip. Dosage: 100 mg (one capsule per day).

Doxycycline malaria tablets should not be taken by pregnant or breastfeeding women, children under 8 years of age or people with severe liver disease.

Malaria tablets – chloroquine

Since the malaria pathogen is a protozoan, it is not surprising that a protozoicidal drug called chloroquine is also used to prevent the disease. It is a substance that increases the pH level in the malaria protozoa. Chloroquine binds haemoglobin to human erythrocytes (red blood cells) infected by protozoa.

Anti-malaria tablets with chloroquine are taken once a week in a dose of 250 mg. As with doxycycline, these malaria tablets are also started before departure (one week before) and then taken every 7 days during the trip and 4 weeks after returning. Contraindications for chloroquine anti-malaria tablets include eye diseases (including changes in the retina), psoriasis and serious digestive system disorders.

Malaria tablets with chloroquine are effective against infections caused by motile, oval and band forms of plasmodium, but may not work against plasmodium falciparum, which is resistant to this substance.

Malaria tablets – mefloquine

Mefloquine is an organic chemical compound used in the prevention and treatment of malaria. In Poland, mefloquine is not authorised for sale, but it can be legally imported from abroad for specific purposes with the consent of the Ministry of Health upon request of a person travelling to tropical countries.

The mefloquine malaria tablets should be started 1 to 2 weeks before travelling to a malaria risk area. The tablets should be taken at 7-day intervals during the trip and for 4 weeks after returning.

Note: In connection with mefloquine malaria tablets, there is relatively frequent talk of undesirable side effects. What are they?

Malaria medication – when do you need intravenous treatment?

The situation is worse in the case of Plasmodium falciparum) infections, which are the most resistant to medication and which cause the most severe form of malaria – around 20 percent of patients die from its complications. Treatment of malaria caused by the falciparum parasite should definitely take place in the intensive care unit of a hospital and consist of intravenous administration of selected antimalarial drugs. The basic malaria drug for this type is artesunate, which can be replaced by artemether or quinine. In addition, these measures should be supported by malaria tablets belonging to the ACT group.

It is worth mentioning that, according to the recommendations of the Department of Epidemiology and Tropical Medicine, patients from countries outside the malaria risk zone should always be treated as if the disease were in its most severe form, regardless of its clinical symptoms. This is due to the assumed lower resistance of the body to this type of threat, compared to people living in Africa, South Asia and the tropical regions of the Americas.

Malaria prevention

Malaria should be prevented in the first place. Before travelling to a country where malaria is prevalent, patients should undergo so-called chemoprophylaxis. Chemoprophylaxis involves taking tablets before travelling, during the holiday and after returning home. The malaria medication should be tailored to the area the traveller is visiting due to the parasite's resistance to medication. The most commonly used prophylactic drugs include:

doxycycline,

chloroquine,

atovaquone/proguanil

mefloquine.

Atovaquone/proguanil (Malarone) is a drug used for both malaria prophylaxis and treatment. It is an ideal preparation for people who leave at the last minute. The first tablet can be taken one or two days before departure. The medication is taken during the trip and for seven days after returning. Doxycycline works in a similar way: prevention starts one to two days before departure, but the medication must be taken for four weeks after returning. Chloroquine and mefloquine are taken once a week starting 1-2 weeks before departure. They are particularly recommended for long trips and should be taken for one month after returning to your home country. 

Malaria prophylaxis: malaria vaccine

Vaccine... Malaria has been taking a deadly toll for as long as anyone can remember, terrifying not only the indigenous inhabitants living in areas where the pathogen and the mosquitoes that transmit it are present, but also visitors - once colonisers and conquerors, today tourists. Nevertheless, the first vaccine against malaria has only been developed now, after decades of research. In 2018, it is to be administered on a pilot basis to 750,000 children in Ghana, Kenya and Malawi. However, we do not know what the results of the pilot will be and whether the malaria vaccine, when used on such a large scale, will prove effective and not have any worrying side effects.

For the time being, there is no anti-malarial vaccine for travellers from Europe. Therefore, malaria remains a disease that must be protected against in other ways. How?

Malaria prevention – mosquito nets

Although it is a method as old as time, mosquito nets are still used to prevent malaria. A mosquito net is a fine-mesh net that acts as a physical barrier to keep mosquitoes and other dangerous insects out. When planning to stay in a hotel in a malaria risk area, we can expect that the windows of our room will be protected by mosquito nets, but it is still worth packing this type of accessory and taking it with us from the country, just in case. In this context, it is worth taking an interest in mosquito nets for hanging over the bed, which will tightly protect the place where we sleep. A mosquito net can also be hung in the garden, over the table - in many situations it is therefore an excellent malaria prevention method. Mosquito nets used for malaria prevention can usually be packed in a handy cover, and the whole thing will not be a big burden when travelling due to its low weight (about 0.5 kg).

Remember that malaria-carrying mosquitoes feed mainly in the evening, so it is essential to protect your sleeping area before nightfall. When entrusting your health and life to mosquito nets, check their condition carefully. Even the smallest perforation can be a gateway for an infected mosquito to get close to you.

Malaria prevention: repellents

Of course, malaria prevention with a mosquito net will only work under certain circumstances, which can be collectively referred to as static. After all, we will not take a mosquito net with us on a hike. In all more dynamic situations, malaria prevention involves the use of so-called repellents. These are chemical agents that do not kill mosquitoes, but repel them relatively effectively, keeping their bloodthirsty tendencies in check.

Repellents are available in the form of sprays, gels, and creams. We use repellents to prevent malaria by protecting all parts of the body exposed to bites, i.e. the uncovered parts such as the hands and face. The active ingredient in repellents is usually DEET or IR3535 (ethyl ester of 3-(N-acetyl-N-butyl)aminopropionic acid).

When used according to the manufacturer's instructions, they provide a relatively high level of protection, although there are numerous restrictions: repellents should not be used by children or pregnant women. Manufacturers also advise against applying them under clothing, as they can cause allergic reactions when combined with sweat. However, it is known that mosquitoes can bite through clothing if it is tight-fitting.