Malarone

May 2001 saw the official launch in the UK of the newly licensed drug Malarone for use as an anti-malarial. Malarone is a combination drug (Atovaquone and Proguanil), which was licensed in the UK back in 1997 for use as a treatment for Malaria.
Manufactured by the drug company GlaxoSmithKline the drug has been shown to be effective in the prevention of P.Falciparum malaria. The main reported side effects seem to have been headaches and stomach irritation, which can be helped by taking the drug with food or a milky drink.
Malarone is already recognised by the Malaria Reference Laboratory and is currently a part of the various databases used in surgeries and travel clinics up and down the country to advise travellers. The drug will be a good alternative for those not wanting to take Mefloquine (Larium) and will be effective in areas of the world where we are seeing increasing Chloroquine resistance. It is important however that is does not get confused with an alternative anti-malarial called Maloprim.
A simple dosing regime, of one tablet per day, means that the drug needs to be started just 1-2 days prior to arriving in a malaria zone, while away and for just 7 days on leaving the area. This is because Malarone has the ability to act on the liver and blood stage of the malaria infection. This simple regime is believed to increase compliance and will be especially convenient for short holidays and last minute trips to malarial destinations.
It is important that travellers understand that this new drug is yet another choice, among others, that might be recommended by a health professional. Often travellers become concerned if they discover they have been given a different anti-malarial to other people on the same plane going to the same destination.
The Malaria Reference Laboratory is responsible for drawing up the anti-malarial recommendations for the UK. Each recommendation involves looking closely at epidemiology of the disease, resistance to the malarial parasite and of course the number of cases that are coming out of certain areas in a particular country. The guidelines then reflect the best 'recommendations' and alternatives as recommended in the UK. These guidelines are then published and updated on a regular basis and it is up to the travel clinic, practice nurse or doctor to keep up to date with the changes within the UK recommendations.
Now, that is not the whole story - recommending the 'right' drug for each person involves a lot more than just looking at a chart and pulling out a drug name. Making a full assessment of each individual and recommending the right drug for a particular individual traveller is often the difficult part. In the case of Malarone as a general rule it will not be recommended during pregnancy or for those breast-feeding, unless it is the last option and the risk is high. We also have not received any data relating to its long-term use, although at an average cost of £36 for a week's holiday, it is more likely it will only be used for short trips. Malarone is also believed to produce lower blood levels for those taking certain medication and this should be discussed with your doctor prior to using any anti-malarial medication.
It is important that when visiting a health professional for advice on anti-malarials that you give them enough information to work with. They need to know where you are travelling to - and be specific; recommendations can differ within a single country or area. Let them know about any stopovers, are you staying in a rural area or in a city - malaria is less of a threat in the cities. What will your altitude be? Malaria is not often found above 2000 metres, although reports from East Africa would suggest changes are occurring in certain parts of the globe.
The time of year is also an important consideration as malaria is seasonal in some areas. The worldwide climatic variations have brought about changes in the pattern of malaria over the last few years. Your health professional will need to know how long you are going to be away as well as your age, and also of importance is the types of medication you are taking and your past medical history.
And that is not the full story - no anti-malarial, however much media attention it receives, is going to be 100% effective and it is important that you also take into consideration how you can prevent getting bitten by mosquitoes in the first place! Recommendations are as they suggest 'recommendations' which, when discussed with your health advisor, might differ from the person sitting next to you on the plane - but it doesn't always mean they've got it wrong…

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.