Travel Health Treatments from UK-Registered Doctors

A pre-travel health consultation should occur ideally 6-8 weeks before departure, allowing time for vaccine courses and prophylactic medication trials.

The assessment covers destination-specific risks, individual medical history, and activity-related exposures.

Malaria risk assessment uses the UK Health Security Agency (UKHSA, formerly PHE) guidelines, which provide country-by-country and region-by-region risk maps updated annually. Key facts:

• Malaria is transmitted by female Anopheles mosquitoes, active between dusk and dawn
• Plasmodium falciparum (predominant in Africa) causes 95% of malaria deaths — it can progress from symptoms to death within 48 hours
• P. vivax and P. ovale cause relapsing malaria (dormant liver hypnozoites) and predominate in South Asia and Central America
• Risk varies enormously by region: rural sub-Saharan Africa carries 10-100x the risk of urban Southeast Asia

Altitude illness affects 25-50% of travellers ascending above 2,500 metres. Acute mountain sickness (AMS) presents with headache, nausea, fatigue, and dizziness.

High-altitude pulmonary oedema (HAPE) and high-altitude cerebral oedema (HACE) are life-threatening complications occurring above 3,500-4,000 metres.

Traveller's diarrhoea affects 20-60% of travellers to low- and middle-income countries. Bacterial causes (E. coli, Campylobacter, Salmonella) predominate.

Stand-by antibiotic therapy (azithromycin or ciprofloxacin) may be prescribed for high-risk destinations.

Pre-travel checklist:

• Review vaccination status: hepatitis A, typhoid, yellow fever (mandatory for some countries), rabies (for prolonged rural travel), Japanese encephalitis, meningococcal ACWY
• Assess malaria prophylaxis need based on specific itinerary
• Discuss sun protection, insect bite avoidance, food and water hygiene
• Review existing medications: some are photosensitising (doxycycline, amiodarone), others interact with prophylactic drugs
• Ensure adequate travel insurance covering medical repatriation
• Patients with chronic conditions (diabetes, cardiovascular disease, immunosuppression) need tailored risk assessments

Three antimalarial prophylactic regimens are recommended for UK travellers by UKHSA. Selection depends on the destination's resistance profile, trip duration, patient comorbidities, and tolerance.

Atovaquone-proguanil (Malarone) is the most widely prescribed regimen for short-to-medium trips. Each tablet contains atovaquone 250 mg and proguanil hydrochloride 100 mg.

It targets the parasite's mitochondrial electron transport chain and folate metabolism.

• Dosing: 1 tablet daily, started 1-2 days before entering the malaria zone, taken daily throughout, and continued for 7 days after leaving
• Advantages: short tail period (7 days vs 4 weeks), excellent tolerability (side effects in under 5%), effective against P. falciparum including chloroquine-resistant strains
• Disadvantages: cost (approximately £2-3 per tablet), taken with food for optimal absorption
• Contraindications: severe renal impairment (eGFR below 30), pregnancy (limited data)

Doxycycline 100 mg daily is a cost-effective alternative at approximately £0.10-0.20 per capsule.

• Dosing: 1 capsule daily, started 1-2 days before entering the malaria zone, continued for 4 weeks after leaving
• Advantages: very low cost, dual protection against rickettsial infections and leptospirosis, some evidence of acne improvement
• Disadvantages: 4-week tail period reduces compliance, photosensitivity (use SPF 30+ sunscreen), oesophageal irritation (take with a full glass of water, remain upright for 30 minutes), vaginal candidiasis in 5-10% of women
• Contraindications: pregnancy, breastfeeding, children under 12, severe hepatic impairment

Mefloquine (Lariam) 250 mg weekly is reserved for long-duration travel where daily dosing is impractical.

• Dosing: 1 tablet weekly, started 2-3 weeks before travel (to assess tolerance), continued for 4 weeks after return
• Advantages: weekly dosing suits long trips, safe in pregnancy after the first trimester
• Disadvantages: neuropsychiatric side effects (vivid dreams, anxiety, depression, psychosis) in 5-25% at varying severity — the MHRA requires screening for psychiatric history. Not recommended for pilots, divers, or those requiring fine motor coordination
• Contraindications: history of depression, anxiety, psychosis, epilepsy, cardiac conduction disorders

Chloroquine and proguanil combination is now rarely used due to widespread P. falciparum resistance across Africa and Southeast Asia.

It remains effective for Central America north of the Panama Canal and parts of the Middle East.

Acute mountain sickness (AMS) is a clinical syndrome caused by hypobaric hypoxia at altitudes above 2,500 metres. The partial pressure of oxygen drops from 21.2 kPa at sea level to 14.

5 kPa at 3,500 m and 10.5 kPa at 5,500 m.

The body's compensatory mechanisms — hyperventilation, increased cardiac output, erythropoietin-driven red cell production — take 3-5 days to develop adequately.

Acute mountain sickness affects 25% of travellers at 2,500 m and 50% at 4,000 m. The Lake Louise AMS score quantifies severity using headache, GI symptoms, fatigue, and dizziness.

Symptoms typically appear 6-12 hours after ascent and resolve with acclimatisation over 24-48 hours.

High-altitude pulmonary oedema (HAPE) occurs in 1-2% of those ascending above 4,000 m. Symptoms include breathless at rest, persistent cough (initially dry, then frothy pink sputum), and cyanosis.

Untreated mortality exceeds 40%. Immediate descent of at least 500-1,000 m is the primary treatment.

High-altitude cerebral oedema (HACE) is rare (0.5-1%) but rapidly fatal without treatment. Ataxia, confusion, drowsiness, and coma develop.

Dexamethasone 8 mg stat then 4 mg every 6 hours is a temporising measure until descent is achieved.

Acetazolamide (Diamox) is the standard prophylactic medication:

• Dose: 250 mg twice daily, started 1 day before ascent and continued until 2-3 days at maximum altitude (or descent begins)
• Mechanism: carbonic anhydrase inhibitor that produces metabolic acidosis, stimulating ventilatory drive and improving oxygenation during sleep (when periodic breathing at altitude is most pronounced)
• Efficacy: reduces AMS incidence by 75-85% in controlled trials
• Side effects: paraesthesia of fingers and lips (universal at therapeutic doses, harmless), increased urination, altered taste of carbonated drinks, rare sulfonamide allergy cross-reactivity
• Contraindication: sulfonamide allergy (disputed — cross-reactivity is rare with carbonic anhydrase inhibitors, but caution is advised)

Ascent guidelines to minimise altitude illness:

• Above 3,000 m, increase sleeping altitude by no more than 300-500 m per day
• Include a rest day (no net altitude gain) every 3-4 days
• Hydrate adequately (3-4 litres per day) — dehydration worsens AMS symptoms
• Avoid alcohol and sedatives during the first 48 hours at altitude
• "Climb high, sleep low" — ascend during the day but descend to sleep at a lower camp

Non-pharmacological measures reduce the risk of malaria by 50-90% and protect against other vector-borne diseases (dengue, Zika, chikungunya) for which no prophylaxis exists.

Mosquito bite prevention (the ABCD approach):

• Awareness of the risk: malaria-transmitting Anopheles mosquitoes bite between dusk and dawn; dengue-transmitting Aedes bite during daytime
• Bite avoidance: DEET-based repellents (30-50% concentration) are the gold standard. Apply to exposed skin every 4-6 hours. PMD (citriodiol) is a plant-based alternative with moderate efficacy. Permethrin-treated clothing provides additional protection — a factory-treated shirt retains repellent activity through 70 washes
• Chemoprophylaxis: antimalarial tablets as prescribed
• Diagnosis: seek urgent medical attention for any fever occurring up to 12 months after return from a malaria-endemic area

Insecticide-treated bed nets reduce malaria transmission by 50% and are essential in rural endemic areas where accommodation is not air-conditioned.

Ensure the net is tucked under the mattress with no gaps and is treated with permethrin or deltamethrin.

Food and water hygiene for traveller's diarrhoea prevention:

• Drink only bottled, boiled, or chemically treated water
• Avoid ice in drinks unless made from purified water
• Eat freshly cooked, piping-hot food — avoid buffets that have been standing at room temperature
• Peel all fruit yourself; avoid pre-prepared salads
• "Boil it, cook it, peel it, or forget it" remains practical advice

Stand-by treatment for traveller's diarrhoea:

• Oral rehydration salts replace fluid and electrolyte losses
• Loperamide 4 mg initially then 2 mg after each loose stool (maximum 16 mg/day) provides symptomatic relief for non-bloody, non-febrile diarrhoea
• Azithromycin 500 mg single dose (or 3-day course for severe cases) covers most bacterial pathogens including fluoroquinolone-resistant Campylobacter common in Southeast Asia

Deep vein thrombosis (DVT) prevention for flights over 4 hours:

• Mobilise regularly during the flight (aisle seat if possible)
• Compression stockings reduce DVT risk by 12-fold in controlled trials
• Adequate hydration; avoid excessive alcohol and caffeine
• High-risk patients (previous VTE, recent surgery, active cancer) may benefit from a single prophylactic dose of low-molecular-weight heparin