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Malaria

Jules Eden, travel medicine specialist and founder of e-med, answers travellers' questions - as published in the following national publications

  • The Guardian
  • Independent On Sunday and/or
  • Geographical Magazine

Q. I am visiting Goa in March and the anti-malarial regime recommended by my travel clinic is proguanil hydrochloride and chloroquine phosphate. I am going with my girlfriend, who is an insulin-dependent diabetic. Will these drugs be safe for her to use, or are there any contra-indications? If not, are there any alternatives for diabetics? (She has problems with antibiotics, so Doxycycline isn't an option). I would be very grateful for your advice.

A. No both of these are fine to take for a diabetic. In fact a diabetic can take any of the available anti-malarials. My only concern would be with Lariam. This is known to cause a few psychological side effects including confusion, depression and irritability.

As these could be warning signs of a potential hypoglycaemic attack, where the sugar gets too low, it would be best to take an anti-malarial where there are no potential pit falls.

So get her the C and P as it is known. But remember there’s more to a diabetic abroad than just the malaria. She must avoid diarrohea, customs if she has needles, and keep her insulin at a good temperature too.

Q. My daughter is 13 and has been diagnosed with ME. Although she is able to attend school and lead a reasonably active life, the ME causes her to get very tired at times and means that she has a very strong and often adverse reaction to 'traditional' medication but seems to react well to alternative remedies (for example homeopathic medication).

On 21st February 2003 we are due to visit Thailand for 1 week. I want to ensure that my daughter gets protection against malaria, but am concerned that available anti-malarial medication will cause her a problem and an increase in the ME symptoms. Are there any alternative anti-malarials (eg homeopathic) available you could advise on? Many Thanks in advance,

A. There is no homeopathic anti-malarial available. But it might be worthwhile looking closely at where in Thailand you are going. If you are just in Bangkok or coastal areas then tablets may not be necessary. There is a low risk here of coming into contact with mosquitoes. However up country on a trek they will be as the place is swarming.

Probably the best tablet for that part of Asia and with least side effects is malarone.

It needs a prescription, but if she has a problem with this you may be best advised to go to a non-malaria area next year.

Q. I'm travelling across East Africa for 3 months and hope to dive in Kenya and Mozambique. My GP has given me a tablet called mefloquine to take against malaria. Is it OK to dive whilst I take this?

A. As you may have read, mefloquine is one of the most recent medication against malaria.

It was developed to combat the drug resistant strains of malaria that were spreading in some parts of the world. The main antimalarial that the malaria parasite was becoming resistant to is chloroquine.

Now as you are going to a chloroquine resistant malaria area then the only way to effectively prevent malaria if you are bitten by the mosquito is by taking this tablet.

But what has become apparent over the last few years is that there are some side effects with this medication. Some of these may mimic decompression sickness and are hard to differentiate, such as tremors, dizziness, rashes and joint pains.

Of course not everybody gets these problems but I would suggest that you will find out by the 3rd or 4th dose if you get them or not.

So take the tablets each week and start them at least this long before you plan to dive so you know how you feel each time you take them. If you find that you get any of these symptoms when you take the tablets then it may well be a good idea not to dive, as if a bend is incorrectly diagnosed as a lariam side effect then there could be disastrous results.

However, there is now news that another antimalarial is on the market that could be a good alternative to lariam. This is called "malarone" and has been recently been released by Glaxo. It is a daily tablet, good against chloroquine resistant malaria and so far showing none of the psychiatric and neurological side effects of lariam. You only need to take it for 2 days before you go and for 7 days when you come back. The only problem is that it is only available in a few places and on a private prescription from your doctor, so it can be quite expensive. If you can get this before you go then it may be a better option than the lariam if you are going to dive.

If you have any problems getting hold of this antimalarial then please contact me.

The other important thing to do is make sure you don't get bitten by the mosquitos, as no medication can really offer 100% protection.

You need to wear long sleeved shirts, avoid swampy areas at dusk, when they come out to feed and use a net at all times when you sleep.

If you are going out to that part of the world for that long, I recommend you join AMREF. This is a charitable organisation that provides a flying doctor service in East Africa. It costs a few pounds to join and they will give you medical support if you have any problems whilst you are out there including flying a medical team out to you if you have a critical illness. The planes are funded by donations like yours but then also serve the local community by flying sick Africans from remote destinations to hospitals in the cities. This one of the best schemes I have seen by which the tourist dollar helps the local population.

You can find them at www.amref.org

Q. In September we are travelling to Borneo. Please can you advise which anti-malarial medication is required? We are worried that it is larium which caused side effects when taken previously. Also, can you advise on a good insect repellant?

A. You have a choice of three antimalarials for Borneo. Lariam or mefloquine is one, but if you have had side effects to it before then stay clear of it this time. Often with this medication people get bad dreams, anxiety and depression. I always advise a test dose before you travel. You don't want to find out you get the night terrors on a dark evening in the jungle.

So that leaves doxycycline and malarone.

Go for the latter as you only have to take it for a week after your return. It's 4 weeks for the doxycycline which is a bore to the taker.

Malarone is a daily tablet, very effective and as it's so new there is little resistance to it worldwide.

The best insect repellents contain a chemical called DEET. Use any brand that has this in it but other travellers recommend a supplement of a locally bought spray. If it works for locals you can be sure it'll work for you.

Q. I have Hepatitis C. Is there any antimalarial I should not take when I go to Kenya?

A. No you can take all of them. When it comes to malaria, it is the disease thought of first and there really is no occasion where another illness should prevent you from taking the tablets.

Malaria can kill, whereas most pre-travel afflictions will only make you feel bad.

If you did have a problem and doctors advised you to never take anti-malarials then sadly it is best to stay away from malaria zones.

Q. I am travelling to Puerta Vallarta in Mexico in a few weeks time. I intend to do some inland touring whilst there. Will I need to take anti-malarial medication and if so what is recommended? Also, am I entitled to get this type of preventative medicine on prescription?

A. If visiting the main tourist destinations in Mexico you do not need any antimalarial medication.

However the latest advice is if going way off the beaten track then a weekly tablet of chloroquine is suggested. This applies more to the verdant swampy South of the country such as the Chiapas or Yucatan. In the North it is more arid and montane in parts and you can get away without taking the tablets.

Sadly antimalarial medication ceased to be an NHS prescribable tablet in the early 90's. This may have led to an increase in the disease as some travellers can't afford the newer more expensive types.

Chloroquine, though is still cheap. You can buy it over the counter at any pharmacy. It needs to be taken for a week before you go and the dreaded 4 weeks on your return. So if your inland touring takes you South then take a tablet before you go. I always pick a Monday to start. M is malaria day. Trust me, it is easy to forget and anything to make it simple to remember can save you a trip to the Tropical Diseases Hospital.



   
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