What are the recommended prophylactic medications for malaria prevention in travelers to endemic areas?

Recommended prophylactic medications for malaria prevention in travellers visiting endemic areas include:

• Suppressive chemoprophylaxis agents such as chloroquine, doxycycline, and mefloquine, which act on the blood (red blood cell) stage of the malaria parasite and should be continued for 4 weeks after leaving the malarious area.
• Causal chemoprophylaxis agents such as primaquine, which target the liver stages of the parasite and need to be continued for 7 days after leaving the malarious area; however, primaquine is not licensed in the UK.

The choice of chemoprophylactic agent depends on the destination, individual risk assessment, and patient factors including comorbidities and potential drug toxicities.

Travellers should obtain chemoprophylaxis from reputable UK sources to avoid substandard or counterfeit medications.

Standby emergency medication may be considered for travellers visiting remote areas more than 24 hours from medical care, but it is not a replacement for regular chemoprophylaxis and should be a different drug to reduce resistance risk.

Personal protective measures against mosquito bites remain the first line of defence and should be used in combination with chemoprophylaxis.

It is essential to complete the full course of prophylaxis, including the post-travel dosing period, to reduce the risk of malaria.

For travellers with HIV, chemoprophylaxis options should be discussed with their HIV physician.

Adverse effects and contraindications should be discussed with the traveller to select the most appropriate regimen.

Regularly updated guidance and drug recommendations can be found on the UK Health Security Agency (UKHSA) and National Travel Health Network and Centre (NaTHNaC) websites.