Malaria vs. Dengue: Medications, Treatments, and What to Do If You Get Sick While Traveling
Getting sick on the road is never fun. Getting sick with malaria or dengue can be scary—because they can look similar at first (fever, chills, body aches), but the right treatment paths are very different. This guide explains, in traveler-friendly language, which medications and treatments are used for malaria and dengue, what doctors are trying to achieve, what you should avoid, and when to treat it like an emergency.
Important: This article is for general education and travel planning, not personal medical advice. If you suspect malaria or dengue, seek urgent medical care—especially if symptoms are severe or getting worse.
Quick takeaway: malaria has specific curative drugs; dengue is supportive care (fluids + monitoring)
Here’s the single most useful mental model: Malaria is treated with specific anti-parasitic medications (the right drug depends on species, severity, drug resistance, pregnancy status, and more). Dengue has no routine “kill-the-virus” medication for most people—treatment focuses on hydration, careful fluid management, fever control, and watching for warning signs.
Related:
• Protect Yourself from Malaria and Dengue: Essential Tips for Safe Travel in the East
Before treatment: why diagnosis matters (and why “just take antibiotics” is a bad idea)
When you’re traveling, a fever can come from many causes: influenza, COVID, typhoid, rickettsial infections, heat illness, foodborne infections, and more. But in many tropical regions, doctors treat fever + travel as “malaria until proven otherwise,” because malaria can deteriorate quickly if untreated.
In clinics and hospitals, malaria is usually confirmed with a rapid diagnostic test (RDT) and/or a microscope blood smear. Dengue is often diagnosed using NS1 antigen testing (early), PCR (where available), or antibody tests (later in illness), plus clinical criteria.
Don’t self-treat with random antibiotics “just in case.” Antibiotics don’t treat dengue, and they don’t treat malaria (with rare exceptions where certain antibiotics are used alongside antimalarials as part of combination regimens). Getting the right diagnosis early is what protects you.
Malaria treatment: what you’ll be given (and why it depends on the type)
Malaria is caused by Plasmodium parasites (most commonly P. falciparum and P. vivax, plus P. ovale, P. malariae, and P. knowlesi). Treatment choice depends on:
- Species (especially whether it’s falciparum or vivax/ovale)
- Severity (uncomplicated vs. severe malaria)
- Where you caught it (drug resistance patterns differ by region)
- Pregnancy and breastfeeding
- Age/weight
- Other health conditions (kidney/liver disease, heart rhythm risk, etc.)
- G6PD status (important for “radical cure” drugs)
Uncomplicated malaria (you’re stable, alert, able to drink): common medication options
For uncomplicated malaria—especially P. falciparum from areas with chloroquine resistance—clinicians typically use one of several proven regimens. In CDC guidance, artemether-lumefantrine is a preferred option when available, and atovaquone-proguanil is another major option; alternatives include quinine plus doxycycline/tetracycline (or clindamycin in certain groups), and mefloquine only when other options can’t be used.
In real travel life, what you receive often depends on the country’s national protocol and local pharmacy availability. Many regions rely on ACTs (artemisinin-based combination therapies) because they work fast and reduce the chance of resistance when used properly.
Severe malaria (medical emergency): IV artesunate is the cornerstone
Severe malaria is an emergency. Warning signs include confusion, repeated seizures, severe weakness, breathing difficulty, jaundice, shock, severe anemia, kidney failure, or inability to take oral medication.
The standard of care in many settings is parenteral (IV) artesunate. CDC dosing guidance describes 2.4 mg/kg IV artesunate at 0, 12, and 24 hours, with further dosing based on clinical situation until oral therapy can be started.
If parasite density remains high or the patient can’t take oral medication yet, treatment can continue with additional IV artesunate dosing (under clinician direction), then transition to a complete oral regimen when feasible.
Translation for travelers: if you’re very ill, the first lifesaving step is getting to a facility that can deliver IV antimalarial therapy plus monitoring and supportive care. This is not a “sleep it off in the hostel” situation.
“Radical cure” for P. vivax and P. ovale: preventing relapse needs extra medication
P. vivax and P. ovale can hide in the liver as dormant forms (hypnozoites) and cause relapses weeks or months later. That’s why treatment often has two layers:
- Blood-stage treatment to clear parasites causing current illness
- Anti-relapse (“radical cure”) treatment to clear liver-stage forms
Two important drugs for anti-relapse therapy are primaquine and tafenoquine. These drugs can cause hemolysis in people with G6PD deficiency, so G6PD testing is required before tafenoquine and is a key safety step for primaquine use.
Tafenoquine has specific age/use restrictions in guidance (for example, CDC notes tafenoquine for anti-relapse therapy in certain age groups and contexts). A clinician will choose the safest plan based on your test results and your situation (pregnancy, breastfeeding, age, other meds).
Supportive care for malaria: it’s more than just pills
Even with the right antimalarial medication, malaria can cause dehydration, low blood sugar, anemia, kidney stress, and other complications. In clinics, treatment often includes:
- Fluids (oral or IV depending on severity)
- Fever control (usually acetaminophen/paracetamol)
- Monitoring (vital signs, urine output, repeated blood tests)
- Treatment of complications (blood transfusion for severe anemia, dialysis for kidney failure, oxygen/ventilation support if needed)
Practical travel note: if you’re in a remote area, the most important decision is often where you get treated. For severe symptoms, prioritize a facility with inpatient capability, lab testing, and emergency care—even if it means traveling to a bigger city.
Dengue treatment: no routine antiviral—fluids, acetaminophen, and careful monitoring save lives
Dengue is caused by dengue virus (DENV), transmitted mainly by Aedes mosquitoes. The main danger is not usually the fever itself—it’s what can happen around the time the fever starts to drop: plasma leakage, shock, bleeding, and organ impairment in severe cases.
Dengue warning signs you should never ignore
Many dengue cases can be managed as outpatient illness—but only if you have no warning signs and can maintain hydration. CDC lists dengue warning signs such as abdominal pain/tenderness, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy/restlessness, and liver enlargement.
If warning signs appear, you need medical evaluation and close monitoring. Dengue can worsen quickly within hours during the “critical phase.”
Fever and pain control in dengue: what to take and what to avoid
Standard guidance emphasizes acetaminophen (paracetamol) for fever and pain. CDC dengue case management guidance explicitly warns against ibuprofen or aspirin-containing drugs because of bleeding risk.
In plain terms: use paracetamol as directed, avoid NSAIDs unless a clinician specifically tells you otherwise, and don’t “stack” multiple cold/flu medicines that might secretly contain acetaminophen (that’s how travelers accidentally overdose).
Hydration is the main treatment—BUT more fluid is not always better
Dengue care is all about getting hydration right. Mild cases typically emphasize oral fluids and reassessment. If IV fluids are needed, current guidance stresses using only the minimum needed and adjusting based on perfusion and urine output.
A key nuance many travelers don’t know: dengue can cause fluid to “leak” into third spaces (like around the lungs or abdomen). That’s why clinicians avoid certain fluids and avoid giving unnecessary IV fluid. CDC’s pocket guide includes “don’ts” such as not using half-normal saline and not assuming IV fluids are always necessary.
What clinicians do in dengue with shock
If a patient develops compensated or hypotensive shock, treatment becomes urgent and protocol-driven. CDC’s dengue pocket guide outlines inpatient management using IV crystalloid boluses, frequent reassessment, and escalation when response is inadequate.
If a patient doesn’t respond to repeated crystalloid boluses, guidance discusses switching to colloids for refractory shock and evaluating for bleeding when hematocrit drops with persistent shock.
This is why dengue should not be self-managed once warning signs appear: clinicians are tracking patterns in vital signs and labs (like hematocrit) to decide whether the body is leaking fluid or bleeding, and the response differs.
Platelets and steroids: common myths that can make dengue worse
Two persistent dengue myths are “give steroids” and “give platelets early.” CDC’s pocket guide advises:
- Don’t use corticosteroids routinely (can increase risks like GI bleeding and immunosuppression).
- Don’t give prophylactic platelet transfusions just for a low platelet count, because it doesn’t reduce severe bleeding risk and may contribute to fluid overload.
Travelers sometimes panic when they hear “platelets are low.” Low platelets are common in dengue—but the decision to transfuse is based on clinical bleeding and overall status, not just a number.
Malaria and dengue together: coinfection and “don’t guess” medicine
In some regions, malaria and dengue circulate at the same time. It’s possible (though not the norm) to have both. The tricky part: early symptoms overlap, but the management priorities diverge.
If you have a travel fever and you’re in (or recently were in) a risk area, the safest approach is: get tested, don’t mask symptoms with risky medications, and don’t delay care if symptoms are severe.
Traveler checklist: what to do if you suspect malaria or dengue
Step 1: Treat fever after tropical travel as urgent until proven otherwise
If you develop fever during travel or within weeks after leaving a malaria or dengue area, don’t “wait it out” for days. For malaria especially, delays can be dangerous.
Step 2: Get tested the same day (or as soon as possible)
Ask specifically about: malaria RDT and/or blood smear, dengue testing (NS1 early in illness), and basic labs (CBC, hematocrit, liver enzymes) if dengue is suspected.
Step 3: Avoid the classic mistakes
- Don’t take ibuprofen or aspirin if dengue is possible (bleeding risk).
- Don’t self-prescribe steroids for dengue.
- Don’t assume “IV fluids are always good”—dengue fluid management is careful and minimal.
- Don’t delay antimalarial treatment once malaria is confirmed—clinicians typically start promptly.
Step 4: Know the emergency triggers
Seek emergency care immediately if you have any of the following:
- Confusion, fainting, seizure, severe weakness, or trouble breathing
- Signs of shock (cold/clammy skin, severe dizziness, very fast pulse)
- Bleeding (vomiting blood, black stools, heavy vaginal bleeding)
- Persistent vomiting or inability to keep fluids down
- Severe abdominal pain
- Very little urine output
- Yellowing of eyes/skin (jaundice) or severe dark urine
These can indicate severe malaria, severe dengue, or another dangerous tropical infection—and they require urgent evaluation.
What medications should you “carry” as a traveler?
This is where travel blogs can accidentally cause harm, so let’s be careful and practical. In many countries, antimalarials and other prescription drugs are regulated, dosing depends on diagnosis, and counterfeit meds can be an issue in some markets.
Smart, safe travel kit basics
- Oral rehydration salts (ORS) (excellent for fever illnesses and diarrhea)
- Acetaminophen/paracetamol (for fever/pain)
- A thermometer (objective data beats “I feel hot”)
- Electrolyte drinks (or powder packets)
- Insect repellent and a plan to avoid bites (helps prevent spread in dengue households, too)
About standby malaria treatment (SBET)
Some experienced travelers discuss carrying standby emergency malaria treatment. Whether that’s appropriate depends on your itinerary, access to medical care, and your personal health situation. This is something to plan with a travel clinician before your trip—especially because the “right” regimen depends on region and resistance patterns.
FAQ
What is the best medicine for malaria?
There isn’t one universal “best” medicine. For uncomplicated malaria, common regimens include artemisinin-based combination therapies like artemether-lumefantrine and options like atovaquone-proguanil, with alternatives used when needed. Severe malaria typically requires IV therapy such as artesunate under hospital care.
Is there a specific antiviral drug for dengue?
For most cases, dengue treatment is supportive: hydration, monitoring, and acetaminophen for fever. Protocols focus on warning signs and careful fluid management, not routine antivirals.
Why can’t I take ibuprofen for dengue?
Dengue can increase bleeding risk, and guidance advises avoiding ibuprofen or aspirin-containing drugs during dengue illness.
Do low platelets mean I need a platelet transfusion in dengue?
Not automatically. Guidance cautions against prophylactic platelet transfusions just for low platelet count, as they don’t reduce severe bleeding risk and may cause harm like fluid overload. Clinicians consider the full picture: bleeding, hemodynamics, labs, and phase of illness.
Why do some malaria patients need primaquine or tafenoquine?
For P. vivax and P. ovale, relapse prevention may require additional therapy targeting dormant liver stages. These drugs require safety screening such as G6PD testing.
Final words for travelers: speed + the right care beats “toughing it out”
If you remember nothing else: Malaria is treatable with the right drugs, but delay can be dangerous. Dengue needs smart supportive care—especially hydration and monitoring for warning signs.
When you’re far from home, the best travel “treatment plan” is actually a logistics plan: know where the nearest reliable clinic/hospital is, have travel insurance that covers hospital care, and don’t gamble with tropical fever.
