QUESTION

My daughter has recently returned from a trip to Borneo. Even with aggressive preventive anti-mosquito behaviour (long sleeves/pants, deet applications and mosquito netting) but not anti-malarial medication, she received over 30 bites. She is now exhibiting some symptoms (body aches, headache and severe fatigue). She has an appointment at the doctors in 2 days time. Is there some kind of post-trip medication (like doxycycline) she can take as a precaution even if the malarial test comes back negative at this early of a time. Thanks.

ANSWER

The important thing to note here is that if your daughter has symptoms of malaria, then she should be diagnosed and, if positive, treated with medication aimed at curing active malaria. Doxycycline is NOT a drug used for the treatment of malaria, so there is no point taking it if she is already exhibiting symptoms.

Furthermore, some types of malaria found in Borneo (notably P. falciparum and P. knowlesi) can become more severe very quickly – 2 days may be too long to wait. If you live in an area where malaria transmission occurs, you may be able to buy a self-testing kit (also known as a rapid diagnostic test, or RDT) for malaria in a local pharmacy. Otherwise, if your daughter’s symptoms get worse, you should take her to an emergency room and explain her travel history and subsequent risk of having malaria.

There is no substitute for taking prophylactic malaria medicine; it might be that if your daughter had started taking prophylactic medicine as soon as she started receiving multiple mosquito bites, then she may have been protected to some degree. However, malaria has a latent period, and so she would have had to continue taking the medication for a period of time after returning home as well – with doxycycline, this means taking the drug for a further four weeks.