By Dr James Knox, Infectious Diseases Specialist
Last updated: September 2025
Planning a trip overseas? If your destination is in the tropics — from Bali to Africa to parts of the Pacific — malaria might be a risk you can’t ignore. It’s a disease that claims more than 600,000 lives each year worldwide and can make travellers dangerously ill within hours of their first symptoms.
So what’s the best way to stay safe? Alongside mosquito bite prevention, one of the most effective tools is taking anti-malarial tablets.
This guide will walk you through:
- Where malaria occurs
- What symptoms to watch for
- Which anti-malarial medications are available
- How to decide if tablets are right for your trip
- Practical tips for starting, stopping, and travelling with them
Contents
- What is Malaria?
- What Are the Symptoms of Malaria?
- Where in the World is Malaria a Risk?
- Do I Need Anti-Malarial Tablets?
- Which Anti-Malarial Tablets Are Available?
- When to Start and Stop Taking Them
- Tips for Travelling with Medication
- Can I Still Get Malaria While Taking Tablets?
- Summary
What is Malaria?
Malaria is caused by parasites transmitted through the bite of infected female Anopheles mosquitoes. After a bite, the parasite travels first to the liver, then into red blood cells. This triggers cycles of fever, chills, and fatigue — and, in some cases, severe complications affecting the brain, lungs, and kidneys.
There are several species of malaria parasites:
- Plasmodium falciparum – the most dangerous and life-threatening, common across Africa.
- Plasmodium vivax & Plasmodium ovale – more common in Asia and the Pacific; can relapse months later.
- Plasmodium malariae – less common, usually milder.
- Plasmodium knowlesii – seen in Southeast Asia, can cause severe illness.
What Are the Symptoms of Malaria?
Symptoms can appear 1–4 weeks after infection (sometimes later with vivax or ovale malaria). They include:
- Fever and chills
- Sweating
- Headache
- Muscle aches and fatigue
- Nausea and vomiting
Severe malaria, especially falciparum malaria, can cause:
- Confusion or seizures
- Breathing difficulties
- Severe anaemia
- Organ failure
⚠️ Medical tip: If you develop a fever during or within a month after travelling to a malaria area, seek urgent medical attention. Malaria can be fatal without prompt treatment.
Where in the World is Malaria a Risk?
Malaria is present across many tropical and subtropical regions, generally below 1,500–2,000 metres in altitude.
Common destinations where malaria may be a concern for Australian travellers include:
- Indonesia – Bali (outside main resort areas), Lombok, and eastern islands
- Southeast Asia – Thailand, Cambodia, Vietnam, Laos, Myanmar (regional variation)
- Pacific Islands – Papua New Guinea, Solomon Islands, Vanuatu
- South Asia – India (risk in many regions, including cities)
- Africa – widespread risk across most countries
- Central & South America – certain parts of Brazil, Peru, and Central American countries
đź’ˇ How to check your risk:
The CDC Malaria Map provides up-to-date, country-specific guidance. Risks can change over time, so always confirm close to your departure date.
Do I Need Anti-Malarial Tablets?
If you are travelling to an area where malaria is present, anti-malarial tablets (also called malaria prophylaxis) are recommended for most travellers. They significantly reduce your risk of infection and are considered an essential part of malaria prevention.
Other prevention strategies include:
- Using insect repellent (DEET, picaridin, or oil of lemon eucalyptus)
- Sleeping under insecticide-treated nets
- Staying indoors between dusk and dawn (when Anopheles mosquitoes bite)
- Choosing accommodation with screens or air conditioning
⚠️ High-risk groups
- Pregnant women – higher risk of severe complications; limited tablet options available.
- People visiting friends and relatives – even if you grew up in a malaria region, immunity fades quickly after leaving.
The safest approach is to book a pre-travel consultation at least 6–8 weeks before departure. A doctor trained in travel medicine can advise which medication is best for your trip.
Which Anti-Malarial Tablets Are Available?
Here’s a comparison of the main options available in Australia (view in landscape mode on a phone or tablet):
| Medication | Dosing | Pros | Cons | Who Can’t Take It? |
|---|---|---|---|---|
| Doxycycline | Daily | Inexpensive; widely available. | Can cause sun sensitivity, stomach upset, thrush. | Not for kids <8 or pregnancy. |
| Mefloquine | Weekly | Good for long trips; safe in pregnancy. | Can cause mood changes, vivid dreams, rare psychiatric side effects. | Not for people with anxiety, depression, seizures, or some heart conditions. |
| Atovaquone-Proguanil (Malarone) | Daily | Well tolerated; short 1-week post-travel dosing. | More expensive. | Not for pregnancy, breastfeeding, young infants, or kidney disease. |
| Tafenoquine | Daily x3 then weekly | Covers dormant parasites (vivax/ovale); short post-travel dosing. | Requires G6PD blood test; psychiatric cautions; expensive. | Not in pregnancy/breastfeeding. |
| Chloroquine | Weekly | Inexpensive; safe in pregnancy. | Resistance widespread; limited use. | Only useful in a few regions (e.g. parts of Central America, Caribbean). |
đź’ˇ Key point: The right tablet depends on your destination, medical history, and trip details.
When to Start and Stop Taking Them
-
Start before travel:
- Doxycycline & atovaquone-proguanil: a few days before arrival
- Mefloquine: ideally 2 weeks before (to test tolerance)
- Tafenoquine: three daily doses in the week before departure
- Chloroquine: 1–2 weeks before
-
Continue after travel:
- Doxycycline, mefloquine, chloroquine: 4 weeks after leaving
- Atovaquone-proguanil, tafenoquine: only 1 week after leaving
This ensures you’re protected during the parasite’s incubation period.
Tips for Travelling with Medication
- Carry a doctor’s letter stating the medication is for your personal use.
- Keep tablets in original packaging and in your carry-on bag.
- Buy in Australia before leaving to avoid counterfeit risks abroad.
- Take with food or water as directed to reduce side effects.
Can I Still Get Malaria While Taking Tablets?
Yes. No anti-malarial is 100% protective. But tablets reduce your risk significantly — and if malaria does occur, illness is usually less severe.
That’s why bite avoidance + tablets + medical awareness together give you the best protection.
Summary
Malaria remains one of the most serious health threats for travellers to tropical regions. The right anti-malarial tablets — combined with mosquito avoidance — provide strong protection.
Your action plan:
- Check if your destination has malaria (CDC).
- Book a pre-travel health consultation.
- Discuss which anti-malarial tablet is right for you.
- Follow the start/stop schedule exactly.
- Seek urgent medical care if you develop a fever during or after your trip.
By planning ahead, you can protect yourself — and still enjoy that tropical holiday.
Frequently Asked Questions About Anti-Malarial Tablets
Do I need malaria tablets for Bali?
Malaria is present in parts of Bali outside the main resort areas. If you’re heading beyond Seminyak or Ubud — or travelling to nearby islands like Lombok or Flores — anti-malarial tablets are usually recommended. Learn more in our Bali travel health guide.
Do I need malaria tablets for Thailand?
Yes, in some regions. Malaria risk is highest in rural and forested border areas (such as near Myanmar, Cambodia, and Laos). Tourist hubs like Bangkok, Phuket, and Koh Samui generally have little or no risk. See our Thailand travel health page for more details.
Can I take anti-malarial tablets if I’m pregnant?
Some tablets are safe in pregnancy, but others must be avoided. Because malaria in pregnancy carries serious risks for both mother and baby, it’s essential to get personalised advice. Find out why a pre-travel medical consultation is recommended in this situation.
When should I start taking malaria tablets before my trip?
It depends on the medication:
- Doxycycline & atovaquone-proguanil: start 1–2 days before entering a malaria area.
- Mefloquine: start 2–3 weeks before travel (to check tolerance).
- Tafenoquine: three daily doses in the week before departure.
Your doctor can tailor the timing. Read more about when to see a travel doctor.
Can I still get malaria while taking tablets?
Yes. No anti-malarial is 100% effective, but tablets significantly reduce your risk. Combined with insect bite precautions, they are the best way to stay safe. For extra tips, see the mosquito bite prevention guide on our malaria page.
Where can I check malaria risk for my destination?
Trusted sources include the US CDC and the Australian Smartraveller website. For advice tailored to your itinerary, book a consultation with Glide Online Travel Clinic.
About the Author
Dr James Knox is an Australian Infectious Diseases Specialist with a Diploma of Tropical Medicine. Having worked in Angola, Sudan, India, and Peru, he founded Glide Online Travel Clinic to make pre-travel health advice more accessible to Australians.