Many people are planning their tropical adventures over the Christmas and New Years holidays, and we are getting a lot of questions regarding which malaria medicines to take. There’s an excellent recent review by the Cochrane Collaboration which helps to clarify this. Many southern and tropical countries near China have mosquitoes that can transmit malaria, and taking a medicine as prevention can dramatically reduce your risks of getting the disease. Resistance to medicine varies by country, but most local countries are still sensitive to the common medicines doxycycline, mefloquine (Lariam), and atovaquone/proguanil (Malarone). But there are some notable side effects, and the recent literature review by the Cochrane Collaboration, the leading group on evidence-based reviews, showed that some medicines, especially mefloquine, may not be as safe as the other two. Here’s their nice summary:

In conclusion, there were differences in the common unwanted effects of the drugs which are currently available to prevent malaria, in adult and child travellers. However, the quality of evidence was overall low. Atovaquone-proguanil and doxycycline are the best tolerated regimens. Mefloquine has more adverse effects than other drugs, and these adverse effects are sometimes serious. However mefloquine may still be an appropriate choice for those travellers who have taken it previously, without any adverse events. Other factors should be considered by prescribers, in addition to tolerability: cost, ease of administration, possible drug-drug interactions, travel itinerary, and the additional protection that may be afforded by doxycycline against other infections, besides malaria.

My favorite malaria prevention medicine for patients is doxycycline, and I’m glad this latest review reinforces its safety profile over the others. It also is usually cheaper, although it must be taken daily, and for 28 days after return from vacation.

Don’t Forget To Do Some Research First

As I’ve mentioned before, travelers should first check a travel website like the US CDC Travel page, and read their country’s description for the latest recommendations on vaccines, medicines, disease outbreaks and security issues. It can provide you a lot of peace of mind. You can read more about malaria in a previous post.