Malaria Prevention Tablets: Which to Choose

If you’re travelling to a malaria area, antimalarial tablets are one of your most important defences. But with three main options available in the UK, which should you choose? Here’s how they compare.

Why malaria prevention matters

Malaria is a serious illness spread by the bite of infected mosquitoes, found across much of sub-Saharan Africa, parts of Asia, Central and South America and Oceania. It can be life-threatening, and the type found in much of Africa is the most dangerous. For most travellers there’s no routine vaccine, so prevention rests on two pillars: avoiding mosquito bites and taking antimalarial tablets (chemoprophylaxis). The tablets work by killing the malaria parasite at a stage of its life cycle, which is why they must be taken correctly — before, during and after your trip. The right choice depends on your destination (and the local pattern of drug resistance), how long you’re travelling, your medical history, your budget and personal preference. Because antimalarials are prescription-only, the choice is made with a prescriber after a travel risk assessment based on NaTHNaC and NHS Fit for Travel guidance. Below we compare the three main UK options to help you understand the trade-offs.

The three main options compared

Atovaquone-proguanil (Malarone)

A popular choice, especially for shorter trips. It’s taken once daily, started just 1–2 days before entering a malaria area, and continued for only 7 days after you return — the shortest post-travel course. It’s generally well tolerated, with relatively few side effects. The main downside is cost, which adds up on longer trips because you take it every day.

Doxycycline

A cost-effective option that suits longer trips. It’s a once-daily antibiotic that also offers some protection against certain other travel infections. It’s started around 2 days before travel and continued for 4 weeks afterwards, which requires good adherence. The main considerations are increased sun sensitivity (use sunscreen and cover up), possible stomach upset, and that it isn’t suitable in pregnancy or for young children.

Mefloquine

Taken once a week, which is convenient for long trips. It must be started 2–3 weeks before travel — partly so that any side effects can be detected before you go — and continued for 4 weeks after return. Mefloquine can cause vivid dreams, sleep disturbance and mood changes, and is not suitable for people with a history of certain mental health conditions, epilepsy or some heart rhythm problems. For the right traveller, the weekly dosing is a real advantage.

How to choose

Ask yourself:

• How long is my trip? Short trips favour atovaquone-proguanil; long trips may favour doxycycline or mefloquine.
• What’s my budget? Doxycycline is usually the most economical for longer stays.
• What’s my medical history? Some conditions and medicines rule out particular options.
• Do I prefer daily or weekly dosing?
• What’s the resistance pattern at my destination? This can determine which tablets are effective.

A prescriber weighs all of this with you — there’s no universal “best,” only the best for your trip.

Bite avoidance still matters

No antimalarial is 100% effective, so tablets are only half the story. Reduce your risk of bites by:

• Using DEET-based repellent on exposed skin
• Covering up, especially at dawn and dusk
• Sleeping under an insecticide-treated net
• Choosing accommodation with screens or air conditioning

And remember: if you develop a fever during or up to a year after travel to a malaria area, seek medical advice urgently and mention where you’ve been.

How to get your antimalarials

The simplest way to prepare is a quick travel risk assessment. You can order malaria tablets online uk after a review by a GPhC-registered prescriber, with delivery before you travel, or visit our Sheffield travel clinic to arrange antimalarials alongside any vaccines you need. Either way, order early so everything is ready in good time.