MalariaProphyllaxis in afya

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1,500-2,000 cases in UK each year - people returning from endemic countries. 
majority (75%) caused by potentially fatal Plasmodium falciparum protozoa.
majority of patients who develop malaria did not take prophylaxis. 
remember UK citizens who originate from malaria endemic areas quickly lose their innate immunity.

Up-to-date charts with recommended regimes for malarial zones should be consulted prior to prescribing

|Drug|Side-effects + notes|Time to begin before travel|Time to end after travel|
|Atovaquone + proguanil (Malarone)|GI upset|1 - 2 days|7 days|
|Chloroquine|Headache, Contraindicated in epilepsy, Taken weekly|1 week|4 weeks|
|Doxycycline|Photosensitivity, Oesophagitis|1 - 2 days|4 weeks|
|Mefloquine (Lariam)|Dizziness, Neuropsychiatric disturbance, Contraindicated in epilepsy, Taken weekly|2 - 3 weeks|4 weeks|
|Proguanil (Paludrine)||1 week|4 weeks|
|Proguanil + chloroquine|See above|1 week|4 weeks|

Pregnant women - advise to avoid travelling to endemic regions - difficult diagnosis (parasites can sequesta in placenta)
    chloroquine can be taken
    proguanil: folate supplementation (5mg od) should be given
    Malarone (atovaquone + proguanil): avoid unless essential. needs folate
    mefloquine: caution advised
    doxycycline is contraindicated

avoid travel with children - do need prophylaxis as they are more at risk of serious complications.
    diethyltoluamide (DEET) 20-50% can be used in children over 2 months of age
    doxycycline is only licensed in the UK for children over the age of 12 years

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