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
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
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…