Malaria Pills

>> I've heard of treatment medication that one can take if hit with malaria.

Oh God, no, you don't want to GET malaria. Ever. It is one of the most serious diseases in the world. And it can reoccur periodically for the rest of your life. It's often been said in the scientific community, that the person who invents a "real" cure for malaria will be "guaranteed" a Nobel Prize immediately.

There are a few good choices for chemoprophylaxis nowadays. Twenty years ago, there was only Lariam, which you had to take long before/after your exposure, and caused both physical and psychiatric symptoms in many people. No need to take Lariam any more.

You will probably want either Atovaquone/Proguanil (Malarone) or Doxycycline. Both of these only need to be taken a couple of days before exposure, and for a week afterwards.

I have taken Malarone, and it was fine. I even climbed Kili while completing my dose, with zero ill effects. It can be a bit expensive, but NOT getting malaria is (as the commercials say) "priceless".

I could not agree more. You want to do almost anything you can do to avoid malaria in the first place. Some strains are extremely hard to cure if you actually get it.

Yes, I know it can be a hassle taking pills, but it is a hell of a lot simpler than trying to cure malaria after the fact.

The different strains pop up in different parts of the tropics. So, you want to get your healthcare provider to look up the facts for each country that you intend to visit. That way you can take the right stuff in advance.

Also, you will find it a lot easier to get the various different prescription drugs in the U.S. If you get to some little village in a remote country, you may not have any of the right stuff available.

–B.G.–

"I've heard of treatment medication that one can take if hit with malaria. Might that be a better route — to carry a supply with me — and use only when needed?"

Take the malarone, as others have recommended, Ben. Malaria, once acquired, is a miserable affliction, and Falciparum malaria is a particular concern. I'd suggest reading the information in the links below, then ask your health provider of a travel clinic if falciparum malaria is present where you will be traveling. If so, redouble your preventive efforts, i.e. sleeping under a net, DEET, permethrin for your clothes/net, and be always aware of where the nearest treatment facility is located, just in case. You don't have a lot of time to get treatment started if you contract falciparum malaria. Not to try and scare you, but it is one very serious disease.

http://www.who.int/mediacentre/factsheets/fs094/en/

http://www.malariavaccine.org/files/FS_Pfalciparum-Sept-2004_FINAL.pdf

http://www.cdc.gov/malaria/diagnosis_treatment/clinicians2.html

Taking "doxy" was not a big deal though it needs to be started a little beforehand. It was just a big pill requiring a gulp of liquid to take down.

Thanks, everyone. More reading to do…

I believe it was Malarone that my son had a seriously bad time with, including sleeplessness and paranoia. He nearly cancelled his trip, stopped the medication, and then everything was fine. You might want to consider taking two types of medication.

There is one type of malaria medication that I took, and its side effect was vivid dreams. I thought, "That can't be very bad." Then I woke up in the middle of a nightmare. That was only one night, but it was something. It scared the hell out of the other trekkers. It is not stupid to test a medication in advance of your departure, just to find out if this sort of thing will be a problem. Sometimes the side effects don't show up until you've been taking it for weeks. Sometimes they show up right away.

–B.G.–

Remember that if you get sick up to 12 months after your visit, to not forget the incubation period even if you took the meds. Let your doctor know.

"Incubation Period
Following the infective bite by the Anopheles mosquito, a period of time (the "incubation period") goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days. The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.

Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area. (This can happen particularly with P. vivax and P. ovale, both of which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)

Such long delays between exposure and development of symptoms can result in misdiagnosis or delayed diagnosis because of reduced clinical suspicion by the health-care provider. Returned travelers should always remind their health-care providers of any travel in areas where malaria occurs during the past 12 months."

http://www.cdc.gov/malaria/about/disease.html

Also, I think that if you have been taking malaria medication, it is assumed that there is a chance that you might get infected anyway. So, I think you are not allowed to donate blood for some period of time after you return.

–B.G.–

I went to the CDC website, and they recommend these three options for the area that I am going to:

o Atovaquone-proguanil
o Doxycycline
o Mefloquine

The only chronic thing I have is that I am a Hep B carrier. That's pretty much it, and I am not noticeably allergic to anything. So, which poison should I pick?

You may not need to pick one.

If you go to a travel clinic for the prescription, they will prescribe the one that they think best… or, the one that they think will be more readily available. You, the patient, can state an opinion, and they might reject your opinion since they are the medical professionals and you are not. Still, you want to be informed before you ever walk in the door.

From time to time, I've studied the subject in advance, so my physician actually listened to me, then searched online to confirm my opinion, and then prescribed the one I wanted.

–B.G.–

True… but good to know some of the pros and cons nevertheless. Right now, I think I am leaning more toward Doxy.

Considering going to a proper doctor, and not just a "travel clinic";. One person at a travel clinic casually prescribed Cipro for me to take for diarrhea; I was suspicious and my regular doctor concurred that you don't blast your system with something like Cipro unless you have run out of other options.

BTW I used Malarone in India last year and it was totally benign-

I spent 4 weeks in Malawi this summer. Malarone was the choice of first worlders. Expense was trivial (every description called it most expensive), but I have health insurance that covered it. Best thing is I only needed to start taking it 3 days before arriving and 7 days after leaving.

DOXY is much cheaper and was avalable over there but required longer dose and had more side effects. Preferred if you have buy a year or more worth of doses.

CDC has a page listing each country worldwide and the types of medications that mosquitoes there have developed resistance to, and their subsequent recommendation.

The descriptions of strange dreams and other psychological symtoms shared in some of the previous posts sound like LARIAM, which was known (and hated) for that.

For that reason, the other choices are now the "most" prescribed; Lariam used to be the ONLY choice. In fact, memories of those psych symptoms are STILL responsible for the negative attitude people have towards that class of drugs, even though the current offerings are completely different (with very few psych effects).

>Consider going to a proper doctor, and not just a "travel clinic".

While Cameron got some bad advice at a "travel clinic", I've found a doctor who practices infectious disease / tropical medicine at an academic center such as a medical school to be ideal. Especially one who does research and clinical work in the area you will travel to. They will have reviewed these same issues for themselves, their staff and their US and foreign patients.

Before going to Zimbabwe, I got three shots in each arm. And was happy to pay $1/day for the best malaria prophylaxis versus the locals who only had the cheapest option with the most side effects. But that was 18 years ago.

Also, discuss with them any drugs you'd want to have with for for diarrhea, vomiting, extreme fungal infections of the skin, etc, especially if you are in a back-country setting. Don't ask for prescription pain killers – they would find that to be a red flag (and a possible problem at border crossings). But ask for guidance on maximum amounts of OTC pain killers. My wife (a physician) broke her arm trekking in Nepal, hiked out two days on Advil, and had the bones set in Nepal but had to go under a general instead of a local because it was all they had – it was the cheapest per dose. Even in a hospital, you might not be able to get a first-line drug because they don't stock it for the locals.

I can't remember which malaria pills I was taking but I will warn you to fart with caution as you figure out the side effects.

I value the advice and knowledge of the RN at our local county run travel clinic than 99% of the physicians in this area. Your travel clinic may vary. I've had success with Cipro resolving a stomach bug but was prescribed amoxicillin for India.

There are other bugs out there, like dengue fever, and 100s of mosquito species, so it's good to know which ones carry what diseases. For example, in parts of Cambodia, some diseases are carried by nocturnal Mosquitos and other diseases are carried by diurnal ones.

Permethrin, deet or picardin, long sleeves, etc.

Doxycycline has been in recent news for skyrocketing price.

I'm an infectious disease researcher who specializes in mosquito born diseases, and specifically in malaria. I travel to subSaharn Africa often and Doxycycline is my drug of choice. Drug resistance exists for mostly all the other options (though this depends on the area of the world you're traveling).

Small issues are that you need to take Doxy daily as well as prior to and after your trip and it does have a side effect of sun sensitivity. This doesn't happen to me, but could easily happen to you. Easy fix is good and consistent sunscreen. If you're going to an area with Plasmodium falciparum malaria I would personally not risk it with the other options and take Doxy.

As for not taking the treatment and risking it, I would recommend against that, especially in an area with Plasmodium falciparum malaria. Once again resistance is the issue. This also pertains to treatments, and if you happen to get one of those strains, you could be in a very very bad way. Even getting it and recovering fully is not something you want to deal with, trust me.

Feel free to PM me if you have any questions. Enjoy the trip.

Thanks for all your insights!!

@Ryan:

Here's my upcoming trip:

Feb – Sudan (Khartoum and the historic north, mostly along the Nile)
Mar – Saudi Arabia
Mar – Ethiopia – Addis and historic north; then Addis to southeast toward Somaliland.
Apr – Somaliland
Apr – Djibouti

As mentioned, I am not particularly allergic to anything — although I am a Hep B carrier. Given this, and excluding cost as a factor, which of the three drugs would you recommend?

I have tolerated doxyc. well on my trips to malaria-prone areas, but must take it with food otherwise it can cause upset stomach. YMMV. I would check on the cost, though. Under my insurance, Malarone is *much* more expensive than doxyc, so the decision is an easy one for me.

"Back in the day", when I served in the Peace Corps, Philippines (1966 – '67), we had to take one Aralin tablet every Sunday as a prophylaxis against malaria. It seemed to work for all of us.

I suppose that medicine has long been superseded by better stuff.

Doxy is what the US military issues us in that region, nowadays. It's cheap, and they were getting some pretty irrational harassment from the media about very rare psychological side effects from some of the alternatives. The downside is that doxy is photosensitizing, so it's easier to get a sunburn.

The upside to doxycycline is that it is broad-spectrum, and will treat other things. For example, it is effective against Lyme disease, pneumonia, clostridial infections, E. coli, Entameoba, etc. So, it might be effective against some form of travel diarrhea, as well as malaria. It will have no effect against viral diseases. It also has some anti-inflammatory effects–in veterinary medicine, we will use it in some cases as a substitute for prednisone, in combination with a vitamin B analog, niacinamide.