Why this is a consultation and not a purchase
Malaria is a parasite carried by Anopheles mosquitoes, which bite between dusk and dawn. Falciparum malaria, the type dominant in sub-Saharan Africa, can kill within days of the first symptoms, and those symptoms are fever, headache and aching - indistinguishable from flu until a blood test is done.
No single tablet suits every trip. Parasite resistance differs by region, so a drug that works in one country is useless in another. Some antimalarials interact with medicines you already take. One is unsuitable in pregnancy, another cannot be taken by people with a history of depression or epilepsy, another makes skin burn more readily in the sun - which matters on a beach holiday.
That is why the price list prices the tablets and the consultation together. You are not buying a box; you are paying a pharmacist to work out which box, for your itinerary and your medical history, and to say so before you pay.
What the choice actually turns on
Five things, in roughly this order: where exactly you are going and in which season, how long you are there, what else you take regularly, your medical history, and how well you cope with a daily tablet versus a weekly one.
Trip length changes the economics sharply. Malarone is taken daily, starting shortly before travel and continuing a week afterwards - excellent for a fortnight, expensive for three months. Doxycycline is far cheaper per day over a long trip but must continue for four weeks after you leave. Lariam is weekly, which suits long stays, and carries the most careful assessment of the three.
- Malarone and Maloff - daily, short post-travel tail, well tolerated, the usual choice for shorter trips
- Doxycycline - daily, much cheaper over a long trip, continues 4 weeks after leaving, increases sun sensitivity
- Lariam - weekly, convenient for long stays, needs careful assessment of mental health history
- Chloroquine - still appropriate for a small number of destinations where resistance has not developed
Bite avoidance is not the afterthought
No antimalarial is completely effective. Tablets reduce the risk substantially; not being bitten reduces it further, and the two together are the actual strategy.
What works: a repellent containing DEET at 50 percent, reapplied more often than the bottle suggests in heat and humidity; long sleeves and trousers from dusk; an insecticide-treated net if your room is not screened or air-conditioned; and treating clothing with permethrin for camping and trekking. Our pharmacists stock what you need and will tell you which of it matters for your trip rather than selling you all of it.
Fever after you get home is an emergency
Malaria can appear up to a year after you return, and most commonly within three months. A fever in that window is a medical emergency until proven otherwise.
Tell whoever sees you that you have been to a malaria area, and say where and when. Doctors in the UK do not always ask, and malaria diagnosed late is far more dangerous than malaria diagnosed early. Keep your travel dates somewhere you can find them.