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), knock-down sprays 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
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 mefloquine
Licensed for prophylaxis in UK.
- Preparations available: Lariam® (Roche). Adult dose is 250mg week.
- One dose should be taken a week before departure and it should be continued throughout exposure and for 4 weeks afterwards, however three (3) doses at weekly intervals prior to departure are advised if the drug has not been used before - this can detect in advance those likely to get side effects so that an alternative can be prescribed.
- Take your tablets with food and plenty of water at the same time on the same day each week. It is very important to complete the course.
- Licensed for one year's continuous use in the UK but there is no evidence that use for periods of up to 3 years carries any greater risk of side effects.
- Mefloquine is unsuitable for those who have a history of severe liver disease, depression, generalized anxiety disorder, psychosis, schizophrenia, suicide attempts, suicidal thoughts, self-endangering behaviour or any other psychiatric disorder, epilepsy or convulsions.
- Those with kidney disease or a heart condition should be assessed carefully before taking this medication.
- Mefloquine should be taken with caution in those suffering from cardiac conduction disorders.
- Side effects may include: nausea, diarrhoea, dizziness, abdominal pain, rashes, itch, headache, dizziness, convulsions, sleep disturbances (insomnia, vivid dreams) and psychotic reactions such as depression.
- Although there is no evidence to suggest that mefloquine has caused harm to the foetus it should normally be avoided during the first trimester of pregnancy or if pregnancy is considered possible within 3 months of stopping prophylaxis. Where the risk of severe malaria is high, mefloquine may be used with caution in the first trimester after careful risk assessment.
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