Malaria is a serious, potentially life-threatening infection spread by mosquitoes, and it is still common in many places Australians love to visit. Australia was certified malaria free in 1981, which means every case diagnosed here is linked to overseas travel.
If your trip includes a malaria area, your travel doctor may recommend malaria tablets alongside mosquito bite prevention. This guide explains where malaria is found, the tablets available in Australia, how they differ, and what to do if you develop a fever after you travel.
Key points
- Malaria is found in parts of Asia, Africa, Central and South America and the South Pacific, including Papua New Guinea, Solomon Islands and Vanuatu.
- Many popular tourist areas, including Bali's resorts and major cities in Vietnam, have no malaria transmission, so not every trip needs tablets.
- Malaria tablets are prescription-only in Australia. The main options are atovaquone-proguanil, doxycycline, mefloquine and tafenoquine.
- Each option has a different schedule before, during and after travel, so the right choice depends on your trip and your health.
- No tablet gives complete protection. Avoiding mosquito bites still matters, and any fever after travel to a malaria area needs prompt medical review.
Need malaria tablets? They are prescription only, so see a TMA travel doctor before you go.
What is malaria?
Malaria is caused by Plasmodium parasites passed on by the bite of infected female Anopheles mosquitoes, which mostly bite between dusk and dawn. Healthdirect describes it as an infection of the red blood cells that can be life-threatening if not treated.
Symptoms usually start 10 to 15 days after infection, but can appear weeks or months later. They include fever, which may come and go, chills and sweats, headache, weakness and muscle and joint aches. Severe malaria can cause confusion, seizures, breathing difficulty and jaundice.
Where is malaria found?
Malaria risk varies within countries, so the exact itinerary matters. Based on CDC country information, examples relevant to Australian travellers include:
- Papua New Guinea: present throughout the country below 2,000 metres.
- Solomon Islands and Vanuatu: present throughout.
- India: present in most areas, including Mumbai and New Delhi.
- Indonesia: present in eastern provinces such as Papua, West Papua, Maluku and East Nusa Tenggara, and in rural parts of Kalimantan, Sumatra and Sulawesi. There is no transmission in the resort areas of Bali, or in Jakarta and Ubud.
- Thailand: mainly in provinces bordering Myanmar, Cambodia and Malaysia. Bangkok, Phuket, Koh Samui and Chiang Mai have little or no risk.
- Vietnam: rural areas of some provinces only, with no transmission in cities such as Hanoi, Ho Chi Minh City, Da Nang and Nha Trang.
- Philippines: Palawan and Mindanao only, with none in metropolitan Manila.
- Sub-Saharan Africa and parts of South America: widespread in many countries, including lowland Peru below 2,500 metres.
Malaria maps change over time, so check your full itinerary with a travel doctor, including side trips, safaris, trekking and island hopping.
Do I need malaria tablets?
Not always. Your travel doctor will weigh up where you are going, the time of year, the length of your stay, your activities and your health. For some low-risk itineraries, careful mosquito bite prevention is enough. For higher-risk areas, tablets are usually recommended.
All malaria tablets in Australia need a doctor's prescription, so you will need an appointment before you go.
Malaria tablets available in Australia
The table below summarises the main options. Timings are based on guidance from the US Centers for Disease Control and Prevention and Australian Prescriber. Your doctor will confirm the exact dose and schedule for you.
| Medicine | Start before travel | While away | After leaving the malaria area |
|---|---|---|---|
| Atovaquone-proguanil (for example Malarone) | 1 to 2 days | Daily | 7 days |
| Doxycycline | 1 to 2 days | Daily | 4 weeks |
| Mefloquine | 1 to 2 weeks | Weekly | 4 weeks |
| Tafenoquine (Kodatef) | Daily for 3 days | Weekly | A single dose in the week after you return |
Atovaquone-proguanil
Atovaquone-proguanil is taken daily and only needs to be continued for 7 days after you leave the malaria area, which suits shorter trips and last-minute travellers. It is generally well tolerated and can be used for children, with doses based on weight. It tends to cost more for long trips and is not suitable in pregnancy or for people with severe kidney problems.
Doxycycline
Doxycycline is an antibiotic taken daily, starting 1 to 2 days before travel and continuing for 4 weeks after you leave. It is often the least expensive option. Healthdirect advises taking it with food and staying upright for at least 30 minutes afterwards to reduce stomach and throat irritation. It also makes your skin more sensitive to the sun, so sunscreen, a hat and covering up are important. It is not suitable in pregnancy or for children under 8.
Mefloquine
Mefloquine is taken once a week, which some long-term travellers find convenient. It needs to be started 1 to 2 weeks before travel and continued for 4 weeks after. It is not suitable for people with certain mental health conditions, seizure disorders or heart rhythm problems, and your doctor will discuss possible side effects with you.
Tafenoquine
Tafenoquine (Kodatef) is taken daily for 3 days before travel, then once a week while away, with a single dose after you return. It is suitable for trips of up to 6 months. Everyone needs a blood test for G6PD deficiency before it can be prescribed, and it is not suitable in pregnancy, while breastfeeding, for children, or for people with a history of psychotic conditions.
What about chloroquine?
Chloroquine is rarely recommended for Australian travellers, as malaria parasites in most regions are resistant to it.
Tips for taking malaria tablets
- Start on time and keep going for the full period after you leave the malaria area. Stopping early can leave you unprotected.
- Take them at the same time each day or on the same day each week. A phone reminder helps.
- Take enough for the whole trip in the original packaging, along with a copy of your prescription.
- Tell your doctor about all your regular medicines and supplements, as some interact with malaria tablets.
- If side effects are a problem, contact your doctor rather than stopping. There is usually another option.
Mosquito bite prevention still matters
Healthdirect notes that anti-malarial medicines do not always work because of drug resistance, and no single precaution gives complete protection. Combine tablets with:
- insect repellent containing DEET, picaridin or IR3535 on exposed skin
- long, light-coloured clothing in the evening, ideally treated with permethrin
- a screened room or an insecticide-treated bed net
- limiting time outdoors between dusk and dawn where you can
See our tips on mosquito protection for travellers and permethrin-treated clothing.
Fever after travel: see a doctor promptly
Healthdirect advises seeing a doctor urgently if you develop a fever while travelling or after returning to Australia from a malaria area, even if you took your tablets. Tell the doctor where you have been. Symptoms can appear weeks or months after you get home.
Frequently asked questions
Can I buy malaria tablets over the counter in Australia?
No. Malaria tablets are prescription-only medicines in Australia. You will need to see a doctor, who can also check your vaccinations for the trip.
Which malaria tablet is best?
There is no single best option. The right choice depends on your destination, how long you are away, your budget, your health and any other medicines you take. Your travel doctor will help you choose.
How long before travel should I see a doctor about malaria tablets?
Healthdirect recommends seeing your doctor or a travel clinic 4 to 6 weeks before you travel. Some options can be started just 1 to 2 days before departure, so a late appointment is still worthwhile.
Do I need malaria tablets for Bali or Thailand?
Usually not for the main tourist areas. The resort areas of Bali have no malaria transmission, and Thailand's popular destinations have little or no risk. Read our guides to vaccinations for Bali and vaccinations for Thailand.
Can children and pregnant women take malaria tablets?
Some options are suitable for children, with doses based on weight. Malaria in pregnancy can be very serious, and several tablets are not suitable during pregnancy, so it is important to get individual advice before travelling to a malaria area.
Get your malaria advice from a TMA clinic
Travel Medicine Alliance (TMA) clinics have substantial experience in travel medicine and can assess your itinerary, prescribe malaria tablets if you need them, and arrange your vaccinations in the same visit. Find your nearest TMA clinic, make an appointment, or call 1300 42 11 42.
This article provides general information only and is not a substitute for individual medical advice. Recommendations change, so speak with your doctor before you travel.
Sources
- Healthdirect: Malaria
- CDC: Choosing a drug to prevent malaria
- CDC: Malaria information by country
- CDC: Thailand traveller information
- Australian Prescriber: Tafenoquine for malaria prevention
- Healthdirect: Doxycycline
- Healthdirect: Malarone
Get your malaria tablets and travel vaccines sorted in one visit.
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