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Malaria prevention medication.

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Would you consider not using it?
5 years ago, September 16th 2008 No: 1 Msg: #48870  
I met a Swiss couple in Kyrgyzstan who were cycling around the world. A clinic in Zurich told them that they should only take Malaria prevention medication for travelling in Africa. They take the Malaria treatment drug with them in case they get Malaria.

Every doctor I have spoken with so far says it is very important to take Malaria prevention medication in many countries. What do you think about what the clinic in Zurich said? I dont like putting drugs in my body when I am not even sick so I like the idea of just carrying the treatment medication with me.

Does anyone know a website where I can get reliable information about the treatment drugs and the dosages for them?

Mel Reply to this

5 years ago, September 17th 2008 No: 2 Msg: #48957  
Hi Mell, I'm not sure of websites, but my dad goes to Africa often for work.

As far as I know, he doesn't take medication for it, and once he told me that the medication they give you only masks the symtoms, and that you basically don't find out you have Malaria until you get back. It means you can do the travelling you need to...but he would much rather know if he was sick immediately, than find out at a later date.

Then again, this was a while back he told me this...they've most probably updated the meds. You could think of it as a flu inoculation. It's the same sort of thing right? Most of the needles you have to get before travelling work in the same fashion...just as a preventative measure.

I'll send an e-mail to my dad, asking about recent trips to Africa....I'll get some updated information. Reply to this

5 years ago, September 17th 2008 No: 3 Msg: #48990  
Thanks Nikky

I think I have 100% decided not to take those Malaria pills on my next trip to India unless I get Malaria. I am beginning to lose my trust in drugs companies. I am not so sure they give out the best information. Selling the drugs seems to be their main motive. Reply to this

5 years ago, September 22nd 2008 No: 4 Msg: #49445  
I haven't taken malaria medication for years. What the clinic in Zurich said is probably quite wise, since most of the malaria medication is extremely bad for your liver. In fact if you are an expat working and living in the tropics you are advised not to take it. Lariam for instance can only be taken for a maximum of 6 month and if you take it that long you are only allowed to take half the dosage. If you take it longer or the full dosage for the 6 month it can damage the liver irrevocably. There are of course other malaria drugs, some less strong, but I think with all of them there is a maximum period of time you are allowed to take them. Another thing is that the pills don't prevent you from getting malaria, they just, as said above, soften (or mask) the symptoms, this is to give you time to go to a clinic. It's a bit like the rabies vaccine, it doesn't stop you from getting rabies, it just gives you more time to get the antidote...

The best way is prevention. Cover yourself in the evenings, put on mosquito repellent and sleep under a mosquito net. And it is also good to know that malaria is not prevelent in the cities, unless you plan to spend a lot of time on the country side or do some jungle trek, the chance of contracting malaria is very low.

Reply to this

5 years ago, September 22nd 2008 No: 5 Msg: #49461  
Thanks Ralf That is very encouraging. I was feeling nervous about going against what so many doctors say. I will be just a few hours from Delhi all the time on my next trip to India. If we get Malaria the cure should be easily available there. Does anyone know if this is the case for sure. Are there good clinics there which have the treatment available all the time? Reply to this

5 years ago, September 22nd 2008 No: 6 Msg: #49481  
You would be extremely unlucky to contract malaria if you are staying just around Delhi... And yes there are good clinics around and good hospitals, especially if you are only going to be a few hours away from Delhi. It is the capital so it would be quite insane and improbable that you wouldn't find a clinic or hospital that has the treatment.

The danger areas in India for malaria are mostly in the extreme north east... Assam, Tripura and that area, as well as certain areas in West Bengal, Orissa, probably Bihar and Jharkand too... But again, only in the country side/jungle... And when I mean you can catch it on the country side, again the chance would be very small if you are just visiting a village for a day or so and not staying the night in some small hut for weeks on end... I suspect you will be staying in a hotel in a bigger city and perhaps make small excursions into the surrounding countryside, so not to worry.

If you want to worry about anything, worry about dengue :-) Unlike malaria, dengue is prevelent in cities and there are constant outbreaks. Unfortunatly it doesn't help to worry about that either, since there is no drug that can stop you from catching it. Reply to this

5 years ago, September 22nd 2008 No: 7 Msg: #49482  
Thanks Ralf Reply to this

5 years ago, September 23rd 2008 No: 8 Msg: #49554  
N Posts: 4
free consultation here. Reply to this

5 years ago, September 24th 2008 No: 9 Msg: #49731  
Hi Mell,
I'm a doctor, I've worked in malaria research and I've lived in malarious areas, so I think I have a few things I could add here. There are a few very important points here - the first one is that malaria is absolutely not something to be taken lightly. It kills over a million people every year, and can do so quickly. There are many non-African countries in which malaria is endemic, and therefore many other countries in the world in which you are at risk of getting malaria.
The important things to think about when you are considering the need for malaria prophylaxis are as follows: firstly, what is the risk of contracting malaria in the place you are going? If you are in a malaria-endemic area, then methods of prevention include 'bite prevention' (avoid being outside at dusk, wear long sleeves, insect repellent, mosquito nets etc) AND chemoprophylaxis. The medications for malaria vary in their ability to prevent malaria, but all do offer very significant protection (some of them offer well over 90% reduction in risk of getting malaria). They also vary in their side effect profiles and how often you need to take them, but generally are pretty well tolerated and most people find that at least one suits them well. If you are in a malarious area and you decide not to take prevention, you need to think about what you are risking. This may not be as simple as just getting a tablet for malaria treatment - people who get really sick with malaria can need intensive care. Will adequate intensive care facilities be available where you are going?
I am not suggesting that you should do one thing or the other, just that it is not something to be complacent about. It is true that many expats living in endemic areas don't take preventative medication for malaria, but this decision relates to many factors including side effects of medications (which are generally less of an issue with short term than long term use) and general dislike/forgetfulness re taking a regular tablet when you are otherwise well. Most people in this situation are very aware of the potential risks and minimise them by being strict about 'bite prevention'.
There are a few things that I suggest that you do to find out about your specific risk for the places you are travelling to:
1) The US government Centre for Disease Control website, www.cdc.gov has lots of useful information about travel medicine. This includes general information about malaria, information about where in the world (including regions within countries) you can get malaria, and info about malaria prevention.
2) Speak to a doctor at a travel medicine clinic. These doctors are used to dealing with this issue and will be able to discuss your specific concerns re medication with you.
Hope this helps clarify some things.
Katherine Reply to this

5 years ago, September 24th 2008 No: 10 Msg: #49732  
Thanks Katherine Yeah, this is what all the doctors tell me. They said take the medication because Malaria is a very serious disease that can kill. I suppose I was hoping that maybe there is another way because I hate taking medication when I am not sick. Thanks for the info. Reply to this

5 years ago, September 29th 2008 No: 11 Msg: #50231  
N Posts: 7
My experience with malaria medication is not good. I have had malaria once and although not the worst thing that I have gotten from traveling, it was certainly far from pleasant.

I took Larium once when I went to Peru and there were 2 major problems with it. On my way to the Amazon, I traveled over the mountains, at an elevation of approximately 5,000m. The effects of altitude sickness seemed much worse when taking the medication than when not. Also, I am epileptic and it caused some fairly significant seizures.

I have since moved to the US, changed doctor and have been warned about taking it due to my epilepsy (obviously my Canadian doctor was not aware of this). The people who live in the jungle say that if you drink at least one liter of grapefruit juice per day, you will not get malaria, but I would not rely on this. I now simply use a lot of insect repellent. Reply to this

5 years ago, September 29th 2008 No: 12 Msg: #50232  
Thanks Dan

Yeah, I heard Larium can cause some mental problems. I never take it because the last thing I need are mental prolems when I travel.

Mel Reply to this

5 years ago, October 5th 2008 No: 13 Msg: #50825  
Hi Mel!
I have been travelling for 5 months in Asia last year. Before leaving, I saw a doctor about this issue. As I was going to travel for a long period, I decided with his agreement not to take the malaria medication for prevention but I bought it so I had it in the event of sickness. I would say that the duration of your trip may be the main point. If there is really a risk regarding the place you are going and if you are travelling only for a short time period, it may be worth to take it.
Reply to this

5 years ago, October 5th 2008 No: 14 Msg: #50870  
Thanks Vanessa

I do like the idea of not taking them for prevention but what Katherine says sounds very convincing. Anyway, we will be seeing a doctor soon and see what she says. Reply to this

5 years ago, October 8th 2008 No: 15 Msg: #51175  
I finally managed to get through to a Tropical clinic in Munich, Germany whose phone line seems to be constantly busy. The recorded message gave me the following information.

Their recommendation was to take Lariam, Malarone or Reamed to India, but contrary to a bunch of other countries they did not specifically recommended profilactic use of Malaria medicine.

This decision to take or not to take the medication for profilactic reasons would be easier to make if I was not taking my 8 year old daughter to India with me. I suppose it is a good sign if not all medical staff insist that it must be taken for profilactic reasons.
Reply to this

5 years ago, October 11th 2008 No: 16 Msg: #51418  
We haven't taken anti-malarials for anywhere we have been. Neil is a doctor, so obviously we trust his assessment! Our travel nurse at home though before we left was trying to force us to take anti-malarials, which we refused. We would much rather take sensible precautions rather than having those levels of anti-biotics in our systems for so long. Our friend took doxy and her nails and hair started flling out after 2 months use. Also Neil used to work with the guy who co-developed Larium and he refused to take his own drug...so that settled it for us!

Mell, remember that some travel clinics and GP's (not all though) get backhanders in the form of gifts etc from the drugs companies that make these anti-malarials...some of the things our travel nurse told us were simply made up and at one point she handed us a leaflet on the 'dangers of malaria' published by Glaxo (the largest maker of anti-malarial treatments) to try and convince us to pay out for the treatment!

You should be fine with India, especially around Delhi, we have just been researching malaria and India and it seems there is a slightly higher risk in Goa but we still don't plan to take anti-malarials, we are just going to use high DEET insect repellant and cover up at night. I think though we will buy the correct anti-biotic treatments and know the correct dosages so we can self-medicate until we can get to a hospital if we display any symptoms. Other people are right that you can still get malaria whilst taking preventative treatments! Reply to this

5 years ago, October 11th 2008 No: 17 Msg: #51424  

We haven't taken anti-malarials for anywhere we have been. Neil is a doctor, so obviously we trust his assessment!



Cool! Another medical professional saying they are not needed. Doctors and nurses seem generally divided on this. But I suppose that is the same for a lot of other medical situations too and not just Malaria. At one end of the spectrum are the medical staff who want to heavily medicate and the ones at the other end are minimilist in their attitude about taking medication. I certainly prefer the more minimilist ones. When one comes in contact with the ones who want to heavily medicate one cant really argue not being a medical professional oneself so it kinda sucks when I am putting 4 types of drugs into my daughter when she just has a flu or chicken pox or other ordinary and rarely/never deadly illness.

I got a letter from a childrens doctor I spoke with last week Thankfully she is of the minimilist group and told me that we dont need to take Malaria medication for profilactic reasons but she will prescribe me a treatment medication in case we get symptoms of Malaria when out in the wilds. We wont be so far out in the wilds that we need it so I think we dont need to bother.

Donna, Would Neil know of a good clinic in Dehli that is well equipped in case we do need any help? Reply to this

5 years ago, October 12th 2008 No: 18 Msg: #51445  
Mell,
I don't think that this issue is as simplistic as dividing doctors into those who 'heavily medicate' and those who are 'minimalist'. The issue is one of weighing up the risks and benefits of each scenario on its own merits. Good doctors are those who understand that, and those doctors may seem to you to be in one camp for some situations and the other camp for others.
There are some situations where the risk of contracting malaria is small and therefore the benefit of taking antimalarials may not outweigh the risk of side effects - many people make the decision not to take antimalarials in these instances. Then there are others in which the risk of malaria is very large. There are places in the world where people get well over a hundred infected bites per year. If you are anywhere near any of those places, obviously the benefit of taking preventative medication is huge.
You just need to weigh up the risks and benefits for each place you are going.
Katherine Reply to this

5 years ago, October 12th 2008 No: 19 Msg: #51457  
I hear what you are saying Katherine and if I had not had 2 doctors here in Munich tell me I dont need to take the medicaction I would never consider going without it.
There are other doctors who told me we do need to take it. What that couple said about the clinic in Zurich is the the first time I ever heard that some are advised to go without the medication. Reply to this

5 years ago, October 12th 2008 No: 20 Msg: #51461  

Donna, Would Neil know of a good clinic in Dehli that is well equipped in case we do need any help?



We haven't been there as yet, so we don't know of any good clinics. I would say once you are there the place you are staying at will be able to direct you to a good clinic, also your travel insurance company would have a list of clinics/hospitals which were acceptable for you to get treatment at, after all it's up to them where you get the treatment!

Neil agrees with Katherine here, there are some places (eg parts of Africa) where malaria is endemic and that you are at high risk of contracting it through mosquito bites and it makes complete sense to take the preventative medication - but there are other places such as India, parts of Indonesia, Cambodia etc where the risk is small that you can chose not to take the preventative medication!

It reminds us of the other argument with our travel nurse about the yellow fever injection...she wanted us to have it but we would only be in a yellow fever 'risk' area for 3 days of our whole trip, we ended up having to present the figures as to why the yellow fever risk was negligable before she would allow us not to have the injection!

You just need to weigh up the risks and benefits for each place you are going.



We agree, Katherine but it's sometimes very difficult for people with no medical training to argue against doctors and travel nurses when they recommend something. If a doctor you trust and have known for years is banging on about malaria and how risky it is not to take preventatives, the majority of people will listen to that doctor, even if they feel that they shouldn't be taking the medication, there is always the feeling that the doctor knows best! Even with medical training it's still difficult to argue against the healthcare professionals - we know and have been through it many times!

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