| No prophylaxis
regimens are 100% effective and it is important
to take the following measures to increase
protection
- Wear long-sleeved clothing, long trousers
and socks when outdoors after sunset. Light
colours are less attractive to mosquitoes.
- Use effective insect repellents on the
skin (propriety products or those containing
DEET are recommended but repeated applications
at intervals are required)
- Use insecticides e.g. coils, mats, sprays
and vapourisers in the bedroom.
- Look out for the signs of malaria. Malignant
malaria (Plasmodium Falciparum) can develop
7 days after being bitten and the benign
form (Plasmodium Vivax) may incubate for
even longer. Typical symptoms are cyclical
bouts of high fever lasting a few hours
accompanied by severe headaches and vomiting.
- Please refer to your GP if any of these
symptoms are experienced within one year
(especially within 3 months) of returning
from an endemic area.
There are two ways to use the site –
use the tables below to access information
yourself, or click the Travelmeds search engine
to automatically calculate regimes suitable
for your travel party. If you have a complicated
regime, or have medication worries, then email
us at info@pcpdirect.co.uk
and we will do our best to help you.
The following lists contain the most current
guidelines for malaria prophylaxis:
No
Risk Areas
Endemic
Areas
Prophylaxis
Regimens
Travelmeds
Search Engine
Dosage
Schedules (including children)
Drug
Related Precautions
No
Risk Areas
To save time, we have printed below a list
of popular destinations, often thought to
have a malaria risk, in which there is currently
no risk of malaria.
| No
Risk Areas |
Antigua
|
Galapagos
|
New Zealand |
Australia
|
Greece
|
Portugal |
Bahamas
|
Grenada
|
Puerto Rico |
Bahrain
|
Hawaii
|
St Lucia |
Barbados
|
Israel
|
Seychelles |
Bermuda
|
Jamaica
|
Singapore |
Canary Islands
|
Japan
|
Tahiti |
Caribbean Islands
(Except
Dom Rep. & Haiti)
|
Jordan
|
Taiwan |
Cayman Islands
|
Kuwait
|
Tenerife |
Chile
|
Lebanon
|
Trinidad & Tobago |
Cook Islands
|
Macao
|
Tunisia |
Cuba
|
Madeira
|
Ukraine |
Cyprus
|
Maldives
|
United Arab Emirates |
Dominica
|
Malta
|
Uruguay |
| Easter Island |
Margarita Island
|
USA |
| Fiji |
Martinique |
Virgin Islands |
* Note: This list is not comprehensive.
|
Endemic
Areas
Use this table in conjunction with Prophylaxis
Regimens list. |
Country
|
Area |
Prophylaxis |
AFGHANISTAN
|
Areas below 2000m between May-November |
PC |
| ALGERIA |
Very low risk, avoid mosquito bites |
R |
| ARGENTINA |
Rural areas near northern border |
C |
| BANGLADESH |
• Chittagong Hill Tracks
•
All other areas. No risk in Dhaka city
|
Mef, Dox, Mal
PC
|
| BOLIVIA |
Amazon basin area.
Other rural areas below 2500m
|
Mef, Dox, Mal
PC
|
| BORNEO |
• Sabah
• Deep forested
areas of Sarawak
• All other
areas of Sarawak
• All of Kalimantan
|
Mef, Dox, Mal
PC
R
PC
|
| BOTSWANA |
Northern half of the country between
November-June |
Mef, Dox, Mal |
| BRAZIL |
• The Amazon basin region, Mato
Grosso and Maranhao
• All other
areas
|
Mef, Dox, Mal
R
|
| CAMBODIA |
• All areas except Phnom Penh
• Mefloquine resistance present
in Western provinces-contact info@pcpdirect.co.uk
|
Mef, Dox, Mal |
| CHINA |
• Yunnan Province and Hainan Island
• Remote rural areas
•
Main tourist areas-very low risk, avoid
mosquito bites
|
Mef, Dox, Mal
C
R
|
| COLOMBIA |
Most areas below 800m |
Mef, Dox, Mal |
| COSTA RICA |
Rural areas below 500m |
C |
| DOMINICAN REPUBLIC |
The whole country |
C |
EAST TIMOR
(formerly part of Indonesia)
|
The whole country |
Mef, Dox, Mal |
| ECUADOR |
• Esmeraldas Province
•
All other areas below 1500m
|
Mef, Dox, Mal
PC
|
| EGYPT |
• El Faiyûm (Al Fayyûm)
area from June to October (this area is
50 miles south west of Cairo)
•
All other areas-very low risk, avoid mosquito
bites
|
C
R
|
| ETHIOPIA |
All areas below 2200m, except no risk
in Addis Ababa |
Mef, Dox, Mal |
| FRENCH GUIANA |
The whole country |
Mef, Dox, Mal |
| GAMBIA |
The whole country |
Mef, Dox, Mal |
| GHANA |
The whole country |
Mef, Dox, Mal |
| GUATEMALA |
Areas below 1500m |
C |
| GUYANA |
All interior regions (sporadic cases
on coast) |
Mef, Dox, Mal |
| HAITI |
The whole country |
C |
| HONDURAS |
The whole country |
C |
| HONG KONG |
Very low risk, avoid mosquito bites |
R |
| INDIA |
• All areas, including Goa, below
2000m
• Assam
|
PC
Mef, Dox, Mal
|
INDONESIA and JAVA –see also Borneo
|
• Irian Jaya and Lombok
•
Rural areas
• Java, Bali, cities
and tourist resorts
|
Mef, Dox, Mal
PC
R
|
| IRAN |
The whole country between March- November |
PC |
IRAQ
|
Northern areas below 1500m and Basrah
province between May-November |
C |
| KENYA |
The whole country |
Mef, Dox, Mal |
| KOREA (North & South) |
Border area between North and South |
R |
| LAOS |
The whole country except Vientiane |
Mef, Dox, Mal |
| MALAWI |
The whole country |
Mef, Dox, Mal |
| MALAYSIA – see also Borneo |
• Peninsular Malaysia deep forest
areas
• All other areas including
Kuala Lumpur and Penang-very low risk,
avoid mosquito bites
|
PC
R
|
| MAURITIUS |
• Rural areas
• Rodrigues
Island and tourist hotel areas-very low
risk, avoid mosquito bites
|
C
R
|
| MEXICO |
• Some rural areas not regularly
visited by tourists
• Low risk
in major tourist resorts, e.g. Acapulco,
Cancun, Puerto Vallarta, Veracruz, Mexico
City and Cozumel
|
C
R
|
| MOROCCO |
Very low risk, avoid mosquito bites |
R |
| MOZAMBIQUE |
The whole country |
Mef, Dox, Mal |
| MYANMAR (formerly Burma) |
• Mefloquine resistance in eastern
part of Shan State-contact info@pcpdirect.co.uk
• All other areas
|
Mef, Dox, Mal |
| NAMBIA |
The northern third of the country; between
November-June. Risk all year round along
Kavango and Kunene rivers |
Mef, Dox, Mal |
| NEPAL |
Areas below 1500m. No risk in Katmandu |
PC |
| NICARAGUA |
The whole country |
C |
| NIGERIA |
The whole country |
Mef, Dox, Mal |
| OMAN |
OMAN Remote rural areas in the north
only. No risk in Muscat |
PC |
| PAKISTAN |
Areas below 2000m |
PC |
| PANAMA |
• East of Panama Canal
•
West of Panama Canal
• No risk
for cruises on Panama Canal
|
PC
C
R
|
| PARGUAY |
Rural areas only |
C |
| PERU |
• Amazon basin area
•
Other rural areas below 1500m
|
Mef, Dox, Mal
PC
|
| PHILIPPINES |
• Areas below 600m
•
Low risk in Cebu, Leyte, Bohol, Catanduanes,
metropolitan Manila
|
PC
R
|
| SAUDI ARABIA |
• Western border cities, Northern,
Eastern and Central provinces
•
All other areas
|
R
PC
|
| SENEGAL |
The whole country |
Mef, Dox, Mal |
| SIERRA LEONE |
The whole country |
Mef, Dox, Mal |
| SOMALIA |
The whole country |
Mef, Dox, Mal |
| SOUTH AFRICA |
North east, low altitude areas of Northern
Province and Mpumalanga and eastern KwaZulu-Natal
down to 100km north of Durban. Risk present
in Kruger National Park |
Mef, Dox, Mal |
| SRI LANKA |
• Low risk in Colombo and coastal
resorts of Galle and Kalutara
•
All other areas
|
R
PC
|
| SUDAN |
The whole country |
Mef, Dox, Mal |
| SYRIA |
Northern border between May-October |
C |
| TANZANIA (inc. Zanzibar and Pemba) |
The whole country |
Mef, Dox, Mal |
THAILAND
|
• All border areas and Ko Chang
island-mefloquine resistance present:
contact info@pcpdirect.co.uk
• All other areas include Chiang
Mai, Bangkok, Phuket, Pattaya and tourist
trips to river Kwai-very low risk, avoid
mosquito bites |
-
R
|
TURKEY
|
• Plain around Adana, Side, south
east Anatolia from March to November
• No risk west of Antalya
|
C
R
|
UGANDA
|
The whole country |
Mef, Dox, Mal |
VENEZUELA
|
• Amazon basin area
•
Rural areas (no risk in Caracas or Margarita)
|
Mef, Dox, Mal
PC
|
VIETNAM
|
The whole country except cities and
Red River delta area |
Mef, Dox, Mal |
ZAMBIA
|
The whole country |
Mef, Dox, Mal |
| ZIMBABWE |
• Zambezi valley and Victoria
Falls
• All other areas below
1200m between November-June
•
Harare and Bulawayo
|
Mef, Dox, Mal
Mef, Dox, Mal
R
|
|
|
| Prophylaxis
Regimens |
Prophylaxis
Mef, Dox, Mal |
Mefloquine one tablet weekly
or
Doxycycline 100mg daily
or
Malarone tablet daily |
Prophylaxis
PC |
Proguanil two tablets daily
or
Chloroquine two tablets weekly |
Prophylaxis
C |
Chloroquine two tablets weekly (preferred
regimen)
or
Proguanil two tablets daily |
Prophylaxis
R |
No chemoprophylaxis required. Use insect
repellents, mosquito nets and wear long
sleeved clothing after dusk. |
|
|
| Dosage
Schedules |
Mefloquine
|
250mg weekly (1 x 250mg)
Lariam tablet. Take 2-3 weeks before travel,
throughout stay and four weeks after return.
Can be taken for up to three years. |
Doxycycline
|
100mg daily (1 x 100mg capsule). Take
1-2 days before travel, throughout stay
and for seven days after return.
Can be taken for up to two years. |
Atovaquone/ Proguanil
|
1 x Malarone tablet daily. Take 1-2
days before travel, throughout stay and
for seven days after return. |
Chloroquine
|
300mg base weekly (2 x 250mg Avloclor
or 2 x 200mg Nivaquine tablets). Take
one week before travel, throughout stay
and for four weeks after return.
May be taken for periods exceeding five
years. |
| Proguanil |
200mg daily (2 x 100mg Paludrine tablets).
Take one week before travel, throughout
stay and four weeks after return.
May be taken for periods exceeding five
years. |
Antimalarial drugs should be taken with food,
and swallowed with plenty of water |
Children’s
Dosages
The following doses are based on guidelines
from the Advisory Committee on Malaria Prevention
for UK travellers.
|
Age
|
Weight
|
Chloroquine tablets
(base)
once weekly
|
Proguanil
once daily
|
Mefloquine
once weekly
|
|
0-12 weeks
|
Under 6kg
|
37.5mg
(1/4 tablet)
|
25mg
(1/4 tablet)
|
-
|
- |
12 weeks-11 months
|
6-9.9kg
|
75mg
(1/2 tablet)
|
50mg
(1/2 tablet)
|
62.5mg (1/4 tablet)
|
- |
1 year-3 years 11 months
|
10-15.9kg
|
112.5mg
(3/4 tablet)
|
75mg
(3/4 tablet)
|
62.5mg (1/4 tablet)
|
- |
4 years-7 years 11 months
|
16-24.9kg
|
150mg
(1 tablet)
|
100mg
(1 tablet)
|
125mg (1/2 tablet)
|
- |
8 years-12 years 11 months
|
25-44.9kg
|
225mg
(11/2 tablets)
|
150mg
(11/2 tablets)
|
187.5mg (3/4 tablet)
|
Adult dose from 12 years 100mg
(1 tab/cap)
|
| 13 years and over |
45kg and over |
300mg
(2 tablets) |
200mg
(2 tablets) |
250mg (1 tablet) |
100mg
(1 tab/cap) |
|
| |
| Malarone (once daily) |
Age
|
Weight
|
Malarone
Once daily |
0-12 weeks
|
Under 6kg
|
- |
12 weeks-11 months
|
6-9.9kg |
- |
| 1 year-3 years 11 months |
11-20kg
|
1 Malarone paediatric tablet |
4 years-7 years 11
months
|
21-30kg
|
2 Malarone paediatric tablets |
| 8 years-12 years 11
months |
31-40kg
|
3 Malarone paediatric tablets |
| 13 years and over |
Over 40kg |
1 adult tablet |
|
| |
| Chloroquine Syrup (weekly
dose) |
Age
|
Weight
|
Chloroquine syrup
|
Under 6 weeks
|
Under 4kg
|
2.5ml
|
6 weeks-5 months
|
4.5-7.9kg
|
5.0ml |
6-12months
|
8-10.9kg
|
7.5ml |
13 months-2yrs
11 months |
11-14kg
|
10ml |
3yrs-3yrs 11 months |
15-16kg
|
12.5ml |
*Note: These dose steps are not the same for
chloroquine tablets, which differ in the chloroquine
content.
Precautions
|
Doxycycline
|
Can alter the metabolism
of oral contraceptives. Patients using
oral contraceptive should take extra contraceptive
precautions for the first three weeks
after starting long – term antibiotics.
Doxycycline can also cause photosensitivity
in 3-4% of patients taking it for malaria
prophylaxis, but this can be minimised
by using high factor sunscreens.
Contra-indicated during pregnancy.
|
Mefloquine
|
Should be avoided in patients with a
history of any type of seizures including
epilepsy or psychiatric disturbances,
including depression..
Not licensed for use in pregnancy and
should be avoided during the first trimester.
|
Chloroquine
|
Should be avoided in patients with a
history of epilepsy.
Can cause flare-ups of psoriasis, so is
not recommended.
May be taken in usual doses throughout
pregnancy.
|
Malarone
|
Should be avoided in pregnancy because
its safety in pregnancy has not been established. |
| Proguanil |
May be taken in the usual dosages throughout
pregnancy but supplement with 5mg of folic
acid daily. |
|
| Hepatic or renal impairment:
Please refer to your GP or consultant.
Breast-feeding and breast-fed infants:
Prophylaxis is still required in breast-fed
infants; although anti-malarials are excreted
in breast milk, the amounts are too variable
to give reliable protection. Doxycycline and
Malarone are contra-indicated in lactation.
Chloroquine and Proguanil are suitable for
use in breast-feeding. Mefloquine may be suitable
in some circumstances.
Pregnancy: Travel to malarious
zones should be avoided during pregnancy.
If travel is unavoidable then prophylaxis
is important as malaria is more severe during
pregnancy.
In General:
Chloroquine and Progaunil
may be taken in usual dosages during pregnancy
but Progaunil should be supplemented with
5mg of folic acid daily.
Mefloquine is not licensed
for use in pregnancy and should be avoided
in the first trimester.
Doxycycline is contraindicated
during pregnancy.
Malarone has no established
safety data for use in pregnancy.
Please refer to your GP or consultant.
To purchase your medicine or obtain an online
prescription please click the link to be sent
to our online pharmacy. www.PCPdirect.co.uk
|
|
