anti malaria medication

[nickg]

Hi

Planning a trip to tanzania - ive been reccommended mefloquine and doxycycline. Mefloquine is the most effective but seems to have some dodgy side effects - not sure which way to go

Does anybody have experience of these drugs one way or the other

Cheers
Nick

 

[2trapper]

Dear Nick,
yes, it's true. mefloquine is an effective and tested drug for malaria prevention and treatment, but it has also several unpleasant side effects, so other drugs are now preferred and suggested. How long are you being in Tanzania?

 

[lou1661]

It does have a bit of a bad rep, I have never taken it but have friends who have with results ranging from no side effects to wacky hallucinations on the night it was taken. Was this advice given by your GP?
I have used atovaquone and proguanil hydrochloride under the brand name of Malarone several times in Africa and seemed to be side effect free for me, however I'm sure it isn't the same for everyone!

Cheers
Louis

 

[Chainsaw]

I normally go for Malarone too, no side effects for me or the rest of the family, not sure if the regimen required for tanzania specifies it or not. OK just checked the BNF and for sub-saharan it recommends meflo, doxy or malarone. I'd speak to your quack, he should have the latest regimen for your area of travel and should know your medical history.

 

[John Fenna]

When I was an exped leader in Africa we hated Malerone ...everyone on it had side effects!
I always used Doxy - and it was great...cleared up my acne and chlamidia as well!
I never got malaria either
This was for Ghana and South Africa - regions vary as to what works best - your GP will have a chart of which is best where.

 

[Retired Member southey]

Used mefloquine for south America and had the runs for the first three weeks there then nothing for the remaining two months, switched to a two pill treatment for air crew when went to Iraq but cant for that life of me remember what it is? shall have an ask around, it doesn't have any psychological effects such as hallucination or drowsiness( a benefit for aircrew!). I think it was some thing like nevoquine and pallodrine(defiantly not the right spelling but sounds right).

 

[sandbender]

Hi

Planning a trip to tanzania - ive been reccommended mefloquine and doxycycline. Mefloquine is the most effective but seems to have some dodgy side effects - not sure which way to go

Does anybody have experience of these drugs one way or the other

Cheers
Nick

Hi

Other than very very weird dreams I had no side effects from Mefloquine and that was with prolonged usage. Malarone had no side effects other than reducing my body's ability to get rid of mouth ulcers, seriously avoid boiled sweets and cola because if you get a mouth ulcer it won't go away and will probably get worse for as long as you are taking Malarone.

I know a few folks with Malaria, it really is something you do want to catch, so keep to you meds.

I also read that certain anti-malarials should be avoided in certain areas in an effort to prevent a resistance building up, no further info. on that though.

 

[Wallenstein]

I used Mefloquine on a trip to Africa - I experienced the trippy dreams others have mentioned, but those were the only side-effects. I'd also had a couple of beers before taking them, which isn't recommended, so that no doubt contributed to the dancing hippos in Lake Malawi!

 

[trekkingnut]

from a financial point of view, dioxycycline is the cheapest. I am off back to borneo in 14 days time for between 6 months and a year so i have just been given 395 tablets by the nhs for less than £20.... pretty damn good value for money if you ask me!

i have not gone down the mefloquine route because quite simply i am very prone to dreams as it is and dont really want to have nightmares whilst being isolated in the middle of the jungle! if i woke up in the middle of the night in my hammock and panicked it wouldnt be a very pleasant experience.

However it should be noted that taking dioxy at the wrong time of day can also be a nuisance. The majority of patients (including myself) find that they become more photosensitive than usual: i.e: if you took it at midday, even with factor 50 suncream, you will get sunburn. The other thing they advise you not to do is take it when you lie down as it can promote excess stomach acid. Why people fall foul of either of these is beyond me. if you take it at dinner time, there will probably be no sun or little sun and i doubt you would be lying down... so really, if you do get sunburnt then its your own fault!

one final advantage of dioxy, again reverting to price per unit, is that BOTH tablets can be used in the TREATMENT of mild to mild/acute malaria in the correct dosage. Now whilst this seems fairly useless if you are taking them as a preventative, i regularly come across unfortunate souls who are in extreme pain due to malaria, and if i have a huge box of tablets costing pence each, you can be sure that they will get enough to help ease the symptoms. now because i go for the cheaper option, i not only have masses of the damn things, but i didnt really pay a lot for them so i am more than happy to spread them around a bit.

you should also check closely in regards to actually taking the medication, for example, dioxy needs to be taken for one month AFTER leaving the malaria zone and there are cases of people having died because they didnt follow this procedure and subsequently contracted malaria several weeks after leaving, they obviously thought it was just flu etc and didnt get it treated.

so things to consider,

side effects
cost
number of tablets required for duration AND the grace period either before or after! (i think meflo needs to be taken two to three weeks before depature)
can the drug TREAT malaria... just in case....

ive rambled on for long enough now but i hope that in amongst all that gibberish that you find at least something useful....

 

[locum76]

Doxycycline worked well for me in Kenya. I had no side effects.

 

[nickg]

Guys

Thanks for the info - i read with interest all you say

Its a two week safari holiday in the Ngorogoro and Kilimanjaro - my GP has suggested that we try mefloquine first and if we dont get on then we try doxycycline second and Malarone
Its a family holiday so i wont find myself alone in the oohloo self sufficient ala Mr Gryllis (famous last words)

Thanks for the info

Cheers
Nick

 

[trekkingnut]

Guys

Thanks for the info - i read with interest all you say

Its a two week safari holiday in the Ngorogoro and Kilimanjaro - my GP has suggested that we try mefloquine first and if we dont get on then we try doxycycline second and Malarone
Its a family holiday so i wont find myself alone in the oohloo self sufficient ala Mr Gryllis (famous last words)

Thanks for the info

Cheers
Nick

if its for such a short trip then id prob go with meflo anyways. just cause itll be easier....

 

[John Fenna]

Have a great time but remember - the best way to avoid malaria is to avoid being bitten.
A good repellant (DEET works but is foul stuff, I am curently trying out Bug -geroff (a South African non deet product) that is working well on Welsh insects) all the time, cover up dawn and dusk (long sleeves/trousers) and sleep under a net that is repellant/insecticide treated.
If the mozzies cannot bite they cannot give you maleria!

 

[SCOMAN]

I would personally not recommend Larium which may be a brand name. I had terrible mood swings with it, everyone had vivid and neon coloured dreams I got the mood swings. It's major advantage was that you didnt need a big lead in before starting it nor a big lead out. But I agree with JF repellant and appropriate clothes/sleeping arrangements.

 

[2trapper]

Have a great time but remember - the best way to avoid malaria is to avoid being bitten.
A good repellant (DEET works but is foul stuff, I am curently trying out Bug -geroff (a South African non deet product) that is working well on Welsh insects) all the time, cover up dawn and dusk (long sleeves/trousers) and sleep under a net that is repellant/insecticide treated.
If the mozzies cannot bite they cannot give you maleria!

I think this is the best advice. Mefloquine is quite dated drug with more side effects (for incindece expecially) than atovaquone/proguanil that is usually well tolerated so for short trips it can be cost effective. Consider also the cost of the treatment (atovaquone is more expensive than mefloquine). If taken for preventing the infection consider the time of drug intake prior and after the permanence in the area. I'm trying to write more about next days about the drugs but you can find here a free article from the BMJ

Tolerability of malaria chemoprophylaxis in non-immune travellers to sub-Saharan Africa: multicentre, randomised, double blind, four arm study

Have a look also at the bibliography: many articles are free and about the question

 

[DS1150]

I've been in India recently and decided on taking doxy due to very minor side effects and cost. Me and my girlfriend had no issues at all with the doxy tabs. You can also buy them online easily.

 

[lannyman8]

i never bothered taking my tabs in Iraq or Afghan, they sent me loopey the last time, as JF said, prevention is better than cure....

 

[torc]

I used to love taking Lariam (Mefloquine) when I travelled in Africa.
We used to have these great conversations about the dreams we had after taking them.
Later, on further study, we realised we were tripping balls.
Oh well, great fun while it lasted.
Happy trails...torc

 

[trekkingnut]

i never bothered taking my tabs in Iraq or Afghan, they sent me loopey the last time, as JF said, prevention is better than cure....

i hope you arent therefore advising people not to take anti malarials..... "prevention" is better than cure and anti malarials are appropriate prevention. Iraq and afghanistan have very specific malarial windows of between about late spring and early autumn and only at low lying levels, he is going to tanzania and they have a malaria threat 365 days a year.

malaria can and does prove deadly and ive watched many a local person suffer in extreme agony and often die.

there are lots of added measures of hats and nets and shirts that you can use of course but at the end of the day, where i work at least, the mosquitoes bite straight through any and all clothing that you are wearing unless its double layered. there is no way im walking round the jungle for six months in a bee keeping outfit.

sorry if i come across as edgy but its difficult to work out whether or not you were joking or not, internet is very unforgiving in that respect....

for a 2 week trip, dioxy will set you back about 44p..... is it really worth taking a chance for the sake of 44p?

 

[John Fenna]

My comments about covering up were meant as AS WELL AS taking your pills!