We follow the CDC's destination guidance for your exact itinerary, offer doxycycline or atovaquone-proguanil (Malarone) within our service scope when appropriate, refer out anything that needs more, and tell you honestly when you need no pill at all. Here is the full method, so you can see the reasoning behind every recommendation.
The steps we follow
Start with the CDC. We use the CDC Yellow Book and the CDC's destination-specific Travelers' Health guidance for each country on your trip. That is the authoritative source for where malaria is and is not, and which drugs are appropriate.
Check region and elevation, not just the country. Malaria risk usually depends on where in a country you go and how high. Many capitals, resorts, and high-altitude areas have no malaria, while a jungle or coastal leg of the same trip does. We map your specific stops, which is why our destination pages answer by region (for example, Peru's Amazon yes, Machu Picchu no).
Match the right drug. The CDC lists the options for each country. We prescribe doxycycline or atovaquone-proguanil (Malarone), which are appropriate for most tourist destinations, and assess health history, interactions, tolerability, cost and the ability to complete the full schedule.
Apply the safety screens. We check for the things that change the answer: drug allergies, isotretinoin or severe kidney disease for the routing between doxycycline and Malarone, and pregnancy or breastfeeding.
Refer out what needs more. If your itinerary needs mefloquine, primaquine, or tafenoquine, or if you are pregnant, we refer you to an in-person travel clinic rather than work around the screening those drugs require.
Say so when no pill is needed. When the CDC does not recommend a pill for your itinerary, we tell you, rather than sell you one. Many trips need only mosquito precautions.
Date it and review it. Every destination page carries a "CDC checked on" date, and we log changes in our data changelog when guidance changes.
What we prescribe, and what we refer
We prescribe: doxycycline and atovaquone-proguanil (Malarone), when they fit the full itinerary and individual health review.
We refer out: mefloquine (needs neuropsychiatric and cardiac screening), primaquine and tafenoquine (need a G6PD blood test), itineraries where neither doxycycline nor atovaquone-proguanil fits every stop, pregnancy and breastfeeding, and vaccines such as yellow fever or typhoid. Typhoid has oral and injectable forms; Bidwell does not prescribe either.
Why we keep the line where we do. An online visit is the right tool when the decision is clear from your itinerary and the drug is one we can manage safely. When a trip needs lab testing, a neuropsychiatric review, a vaccine, or an exam, the honest answer is a travel clinic, and we will tell you that even though it means sending you elsewhere.
We follow the CDC's destination guidance for your exact itinerary, not just the country. Malaria risk often depends on the region and elevation, so a trip to a capital city or a high-altitude area can need no pills while a jungle or coastal leg of the same trip does. We map your specific stops against the CDC's malaria map and tell you what is recommended.
Why do you only prescribe doxycycline and Malarone?
Bidwell offers doxycycline or atovaquone-proguanil when the itinerary and health review fit. Other medicines can require additional screening: mefloquine has neuropsychiatric and cardiac cautions; primaquine and tafenoquine require quantitative G6PD testing. Those medicines are outside Bidwell’s scope, so we refer to a travel-medicine service.
What if the CDC recommends a drug you do not prescribe?
If doxycycline or atovaquone-proguanil is appropriate for every stop and safe for you, a multi-stop trip may fit this service. If neither fits, or you are pregnant or breastfeeding, Bidwell refers you for another travel-medicine assessment. A CDC list containing other drugs does not by itself mean those are the only options.
Do you ever tell people they do not need malaria pills?
Yes, often. Many popular trips, like Cancun, a Bali beach holiday, or Cusco and Machu Picchu, have no malaria, and many low-risk destinations need only mosquito precautions. When the CDC does not recommend a pill for your itinerary, we say so rather than sell you one you do not need.
Share your dates in each risk area, including side trips. A low-risk city does not cancel risk from an earlier jungle or safari stay, and the after-exposure course continues after you leave that area. Check current CDC destination advice before travel; a saved country summary can become outdated.
Earlier review by Bidwell Cranage, APRN, FNP-C, AANP board-certified Family Nurse Practitioner and Member, International Society of Travel Medicine, with clinical review by Ashley Cranage, APRN, FNP-C.
Original review date: June 19, 2026. Sources: CDC Yellow Book and CDC Travelers' Health. See our editorial policy and medical review policy.