[Handsome Creepy Eel]

I'm about to travel and stay for a month to a country with endemic malaria and must pick an anti-malaria medicine to take before, during and after the trip. Here are the options that I have been presented with by my institute and public health and the CDC:

1. Malarone (Atovaquone-Proguanil) - taken daily, no known side effects other than mild stomach distress. Affects the Malaria Plasmodium even in its early stage (as soon as it enters the liver). Enormously expensive.

2. Lariam (Mefloquine) - taken weekly, known for causing diarrhea, psychiatric effects like hallucinations and depression, and neurological effects like dizziness. Affects the Malaria Plasmodium only during its second stage (after it bursts from the liver to infect blood). Expensive but affordable.

3. Doxycycline - taken daily, basic antibiotic used for lots of other stuff, known for causing diarrhea and sun allergy. Affects the Malaria Plasmodium only during its second stage (after it bursts from the liver to infect blood). Cheap or free.

4. Chloroquine - not considered, as local Malaria Plasmodiums have developed resistance to it.

Each one of these medicines has potential problems that I will have to deal with. What did you take? What are your experiences?

What I'm concerned with far more than the side effects is the effectiveness of these medicines. Namely, once you get Malaria you are fucked because you are usually infected for life. Once they've entered the liver, the malaria hypnozoites linger there for up to 30 years and keep reactivating from time to time.

So my primary question is this... since Lariam and Doxycycline don't affect the parasite in its liver stage, does it actually mean that they simply delay Malaria - i.e. the parasite settles inside your liver and just waits until you stop taking the drug? Is Malarone the only option for actually stopping Malaria, not just delaying it? Or am I misunderstanding this mechanism?

Will be very grateful for any answers

[vinman]

I took Doxy in Afghanistan daily for 7 months. So far no problems.

[Texas_Tryhard]

Can I ask where you're going? Feel free to PM if it's too much information to give out publicly. The destination will inform my suggestion.

[Bacchus]

I took Mefloquine for the year that I spent in Manaus, Brazil. I didn't have much reaction to the medicine, except that every night that I took it, it produced vivid dreams. The psychosis effect is real (the pills came with a warning), but also rare. Another good part was that I could bring a years supply with me, and didn't have to bother getting a prescription refilled in Brazil. I didn't get Malaria, despite the countless mosquito bites I got.

[Chaos]

I have used Lariam. No side effects as far as I can tell.

[Phoenix]

[Handsome Creepy Eel]

Thanks everyone. I've PMed Texas

[tarquin]

Has anybody else dealt with this issue lately? I'm going to be bringing over some DEET laden stuff, but I'm hesitant to take any medications as I'll be doing some deep sea diving and I'm a bit worried of any potential interactions. There could also be some interactions which exist otherwise from the drugs themselves. I was scared to death by this: http://www.thisamericanlife.org/radio-ar...ts-unknown The last part is an amazing story, but I'd rather not go through it myself. I'll also be soaking my clothing with permethrin prior to leaving.

Any other tips or ideas to avoid medication? Load up on garlic pills or something?

[MiscBrah]

(03-26-2015 11:08 AM)Handsome Creepy Eel Wrote:  

Thanks everyone. I've PMed Texas

Since this has been bumped, which one did you end up going with?

[ChokingHazard]

(03-25-2015 12:28 PM)Handsome Creepy Eel Wrote:  

I'm about to travel and stay for a month to a country with endemic malaria and must pick an anti-malaria medicine ...
... Will be very grateful for any answers

Do you really want to kill yourself?

You can very easily die from Malaria. About 1/2 million per year do.

Picking the right pills (if any) is not an easy task. Nothing I'd do based on anecdotal "evidence"

It depends on where you travel to. Asia is different to Afrika. The north of Thailand might have a different virus prevalence compared to the south. You could catch it on 40% of the world's surface. Some virus are resistant to some (most?) medication. An air con 5 star hotel which is mosquito aware reduces your risk, sleeping under the sky in a hammock increases it. The situation will be different in 2 years. Some pills might affect your safety when scuba diving, some disturb your visual and create halos around light sources at night. So the girl you might bang might not be an angel after all.


There are lots and conflicting if-thens to consider to determine what is best for you. This is why we have usually well trained medics in centers for tropical medicine. They will ask you some questions and recommend the best strategy - that is what they are there for, why they spent 6 years+ at university. They cannot provide a list of all possible pills and let you chose!

Don't risk your life because someone in this forum also went to Asia and took pill A.

It will cost you a few bucks. Most insurances in Europe won't cover it (however they will pay if you get sick!).

- And yes, there will be someone here who went to a high risk country and took nothing. He will tell you that all this is exaggerated. But also there is (probably) someone who sleeps with Gisele Bündchen and another guy gets killed in car accident. So gamble if you really think it is worth it.
- The German Secretary of State for Trade and Industry caught Malaria on 8 day conference trip a decade ago. Almost died. Probably did not sleep in a hammock there.


By the way there are plenty of other diseases. Dengue fever is a big problem world wide. A friend of mine who cycles 200km a day was sick for 6 months due to that.

Lots of the countries discussed here have a high prevalence of Hepatitis. You catch it by unprotected sex, it affects your liver, and dramatically increases your risk of liver cancer. A simple vaccination can help.



For Malaria:
1. Make sure to understand if / which pills make sense

reduce exposure:

2. Use repellent. DEET or (p)icardin based. Picardin is better for your skin but you cannot buy it e.g. in Thailand.
3. Dress accordingly, white clothes, long sleeves and use special repellent for your clothes as well.
4. use a mosquito net or get an air con room with nets on the windows.

Good news is that those countries where you can catch Malaria are usually good to diagnose it.

So why not having one professional consultation and be protected as much as possible?
Btw, many grown ups lack basic vaccinations which are recommended for US and Europe.

[ChokingHazard]

^^ replace /virus/ with /pathogen/ above.