Malaria tablets are not a one-size-fits-all solution. The right choice depends on your destination, health, and travel plans. Learn the key facts about each option and when to start and stop them.
Malaria remains a serious travel risk
Malaria continues to pose a major threat to global health. The World Health Organization (WHO) recorded 282 million cases of malaria and 610,000 malaria deaths in 80 countries in 2024. The WHO African Region carried 95% of cases and 95% of deaths, and children under 5 accounted for about 75% of all malaria deaths in that Region. Children under five accounted for about 75% of malaria deaths in the African Region in 2024. For travellers from the UK, the risk is real. The National Travel Health Network and Centre (NaTHNaC) factsheet reports 2,106 cases of imported malaria in returned travellers in 2023, with 6 deaths. Notably, 74% of those cases were in people visiting friends and relatives. This group often misses pre-travel advice. Malaria spreads through the bite of an infected female Anopheles mosquito. Simple precautions and appropriate tablets can prevent most cases.
How antimalarial tablets work
Antimalarial tablets are a key part of prevention for travellers. They do not stop mosquito bites but work inside your body to fight the parasite if it enters your blood. The NHS says antimalarial tablets usually need to be started a few days or weeks before travel and continued until a few weeks after return. You must continue taking them during your stay and for a period after leaving the risky area. This schedule ensures the drug is in your system when you need it. It also covers the incubation period of the parasite. Each type of tablet has a different timing. Your doctor or a travel clinic will advise based on your destination and health. Always obtain your medication from a reputable source in the UK before you travel. This avoids counterfeit or substandard drugs abroad.
The ABCD approach to prevention
The UK Health Security Agency and NaTHNaC promote the ABCD approach for malaria prevention. A stands for Awareness of the risk. Know whether your destination has malaria and at what season. B is Bite prevention. Use insect repellent, wear long sleeves and trousers, and sleep under an insecticide-treated net. C is Chemoprophylaxis, the tablets you take. D is Diagnosis, meaning seek prompt medical attention if you develop a fever while abroad or after returning. This framework helps you remember all the steps. The NHS adds that you should get advice at least four to six weeks before travel. Even if you have visited the same place before, the risk can change. Always check current guidance from reliable sources like NaTHNaC or the WHO.
Atovaquone plus proguanil: short stays
Atovaquone plus proguanil is a popular choice for many travellers. The UK Health Security Agency (UKHSA) recommends one tablet daily for adults, containing 250mg atovaquone and 100mg proguanil. You start one to two days before entering a malarious area. Continue throughout your stay and for seven days after leaving. It suits short trips because the stop period is brief. However, it is not suitable for everyone. It is contraindicated if you are allergic to either component and your eGFR is less than 30 mL/minute/1.73m2. Common side effects include headache and gastrointestinal upsets. For breastfeeding mothers, standard adult doses apply, and breast milk gives the infant no protection, so infants need their own prophylaxis. In pregnancy, atovaquone plus proguanil may be used where there is no alternative, with folic acid 5mg daily co-prescribed.
Doxycycline: a daily option with precautions
Doxycycline is another daily tablet for malaria prevention. The UKHSA advises a dose of 100mg daily. You start one to two days before entry and continue for four weeks after leaving. This long stop period means you must plan ahead. Doxycycline is contraindicated if you are allergic to tetracyclines or if you are under 12 years old. It can cause oesophageal irritation and ulceration, so take it with plenty of water while sitting upright. Photosensitivity is another side effect, so use sun protection. Vaginal candidiasis may also occur. In pregnancy, doxycycline should be avoided. In epilepsy, chloroquine and mefloquine are contraindicated, while atovaquone plus proguanil and doxycycline can be used. Always tell your doctor about any medical conditions or medications you take. This includes over-the-counter remedies and herbal supplements.
Mefloquine and chloroquine: weekly alternatives
Mefloquine is taken weekly, 250mg, starting two to three weeks before travel to check tolerability. Continue for four weeks after leaving. It is not for everyone. UKHSA says it is contraindicated in current or previous depression, generalised anxiety disorder, psychosis, schizophrenia, suicidal thoughts, other psychiatric disorders, and epilepsy. It is not recommended for pilots. Side effects can include abnormal dreams, insomnia, anxiety, depressed mood, dizziness and vertigo that may continue for months after it is stopped. In pregnancy, mefloquine can be used in the second and third trimesters and in the first trimester in areas of high risk. Chloroquine is also weekly, two tablets of 310mg, starting one week before entry and continuing for four weeks after. It is safe in all trimesters and available from birth. However, proguanil hydrochloride tablets and chloroquine phosphate tablets have been discontinued in the UK, while chloroquine syrup remains available.
Special groups and the final word
Certain travellers need extra care. Pregnant women face higher risk of severe malaria, and diagnosis can be difficult. The UKHSA advises safe options like chloroquine in all trimesters, or mefloquine later in pregnancy. Infants can use chloroquine syrup from birth, while mefloquine and atovaquone plus proguanil are for those over 5kg. Children under 12 cannot take doxycycline. People without a spleen should avoid travel to malarious areas if possible. The NHS stresses that malaria is a medical emergency. If you develop symptoms while travelling or up to a year after return, seek immediate help. Symptoms include fever, headache, and chills. Early diagnosis saves lives. Always follow professional advice tailored to your health and destination. The right tablet, taken correctly, offers strong protection.
Sources
- Chemoprophylaxis: Malaria prevention guidelines for travellers from the UK 2026: UK Health Security Agency
- Special risk groups: Malaria prevention guidelines for travellers from the UK 2026: UK Health Security Agency
- Malaria factsheet, TravelHealthPro: National Travel Health Network and Centre (NaTHNaC)
- Malaria, NHS conditions page: National Health Service (NHS)
- Malaria, WHO fact sheet: World Health Organization
This article is general information, not medical advice. Ask a doctor or pharmacist about your own health.