A - Be Aware When There is a Risk However Small
- Find out if there is a malaria risk in the area you are visiting.
- Aspects of travel may increase the risk e.g. rural travel, rainy season or unscreened accommodation.
B - Keep Mosquito Bites to a Minimum
- Use clothing to protect the skin, particularly between dusk and dawn when mosquitoes feed.
- Use DEET- based insect repellent on exposed areas of skin.
- Sleep under a mosquito net that is impregnated with insecticide.
- Use air conditioning (if available) and plug in vapourisers to protect your room.
C - Use Antimalarials Correctly
- The antimalarial tablets recommended for you will depend not only on effectiveness but also on suitability, side effects, cost and which regime suits you best.
- Tablets must be taken regularly according to the manufacturer's instructions.
- Delayed illnesses - the incubation period of the less severe form of malaria may be long (up to a year or more).
D - Report any Feverish Illness Promptly to a Doctor
(Particularly within 3 months of return but even up to 1 year and say you have been to a malarious area.)
- You may need to take a supply of personal emergency treatment abroad with you if you are going to be remote from medical facilities since treatment should always be started promptly. Discuss this option with a Travel Advisor or other healthcare professional.
Patient Information Leaflet (PIL) for doxycycline
Licensed for prophylaxis in UK.
- Preparations available: Doxycycline (non-proprietary), Vibramycin® (Invicta).
- Adult dose is 100mg daily. One or two doses should be taken before departure. It should be continued throughout exposure and for 4 weeks afterwards. It is very important to complete the course.
- Take your tablets with food and at the same time each day. If you miss a dose, take one as soon as you remember then carry on as before (you may have to get more tablets). Never take two doses at the same time. Heartburn is common if capsules release their contents into the gullet so they should be taken with a full glass of water and preferably while standing upright and not just before going to lie down in bed.
- No guidance is given by the manufacturers on prolonged usage for malaria prevention but has been used for periods of up to 2 years for acne without an increased risk of side effects.
- Interactions with other drugs: check with your doctor if you are taking regular indigestion remedies, iron or zinc tablets, retinoids (for psoriasis) or cyclosporine. It must be remembered that anti-epileptic drugs (phenytoin, barbiturates and carbamazapine) may reduce the efficacy of the doxycycline.
- Side effects may include: anorexia, nausea, diarrhoea, thrush, sore tongue (glossitis), headaches, blurred vision or tinnitus. Erythema (sun burn) due to sunlight photosensitivity; sunscreens are important and if severe alternative antimalarials should be used.
- Pregnancy: Contraindicated in pregnancy (including for one week after completing the course), breast feeding, in those with systemic lupus erythematosus, porphyria and children under 12 years because permanent tooth discolouration and/or delayed bone development can occur.
- In their 2011 guidance on Drug Interactions with Hormonal Contraception, the Royal College of Obstetricians and Gynaecologists have stated that women on non enzyme inducing antibiotics are no longer required to take additional precautions during or after the course. The use of additional precautions does apply if vomiting or diarrhoea occurs as a result of antibiotic use or underlying illness.
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