 Malarone is also an alternative to chloroquine and paludrine for short stays, if you want to avoid taking tablets 4 weeks after departure from the malaria risk area.
Doxycycline is an antibiotic which can be used to prevent malaria resistant to other drugs. There is less experience with doxycycline than with lariam and malarone. The side effects are mostly an allergic rash on areas exposed to sunlight.
Side effects Comparing chloroquine and paludrine and lariam the risk of mild side effects are about the same, but lariam users have up to four times higher risk of experiencing neuropsychiatric side effects of which difficulty with sleeping is the most common.
Overall 2% to 5% of all users, no matter which drug they use, experience symptoms, which are suspected to be side effects from the drugs and lead to cessation of medication.
Our attitude to malaria prophylaxis
In general the traveller should be offered the most effective drug taking the destination, mode of travel and length of stay into consideration.
In areas with very low risk like for instance Thailand, drugs are not recommended for prophylaxis, only traditional methods like repellents and impregnated mosquito nets.
In area with a high degree of resistance against chloroquine, like tropical Africa and part of South America and South East Asia, we recommend
Malarone as first choice for short-term travellers, and
lariam for long term travellers, both with
doxycycline as an alternative.
Protection should be as good as possible, but it is unacceptable to have the travel spoiled by side effects, if the risk of infection is low.
Traditional protection The malaria mosquito primarily bites between dusk and dawn. The risk of infection can be much reduced by preventing mosquito bites, for instance by sleeping in closed, air-conditioned rooms or rooms with screened windows.
Mosquito nets An insecticide impregnated mosquito net (bed net) around the bed during night offer a good protection, at least 50% reduced risk, if used properly.
Synthetic pyrethroids like permethrin, deltamethrin or lambda-cyhalothrin are usually used for impregnation, which last 6 to 12 months.
The net must be without holes and must be tucked under the mattress or sleeping bag to provide a sealed sleeping space.
The net must to packed during daytime to avoid mosquitoes entering during daytime.
The net should be supplemented with a repellent after dusk before going to bed under the impregnated net.
Repellents can be DEET (usually 20%), Autan and Mossi-guard which are synthetic and protects at least 4 hours.
Some repellents are made of natural oils like citronella and eucalyptus, but usually provide shorter effective protection. An exception is Mossiguard, which has been shown to be equal to DEET 20% in a 50% solution.