Sep 24th, 2005, 12:35 PM
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To ddgattina and all others that question Larium.
All the advise was very helpful. My husband and I are spending two weeks in South Africa in October, driving from Joburg to Cape Town. We don't expect to be in any of the malaria areas. Our primary doctor, when we asked, told us that it really was not necessary to take anything. We read some of the talk on line here and had just about decided not to take anything.
But a visit yesterday to our cardiologist (spelling?) changed that, he told us that we should take the anti-malarials. We are elderly and have some minor heart problems, so we do take his advise. He didn't seem to know the difference between Larium and Malarone, but gave us a prescription for Malarone. Don't doctors usually read up on these meds? Our drugstore didn't have Malarone in stock and needed to order it - good thing we planned early. We're expat New Englanders living in Georgia, so I guess southerners don't usually travel to Africa. Although I hear of a lot of church groups going into the bush; I wonder if they take anti-malarials.
The final decision for us is to take the meds and prevent problems. Malaria would not be fun for us at this stage in our lives.
Have a great trip. - Joan
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Sep 25th, 2005, 03:22 PM
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Hi Joan,
If you are under a doctors care for other conditions, you do need to follow that doctor's advice, BUT also ask hard questions, because as you say, some doctors don't do much travel medicine, so they don't know or keep up on tropical medicine. (Which does change over time.) Especially in an area where people don't travel to exotic locales very frequently. But I have been sometimes shocked by the recommendations of lazy doctors who don't keep up with the times --even doctors who specialize in travel medicine. A few years ago (the first year malarone was approved in the US) I had an argument with one who insisted lariam was the best choice, even when I told him that I had such bad nightmares and sleep disruption that I stopped taking the larium on a trip to India!! He finally relented and gave me prescriptions for both.

The other issue that you brought up is iimportant too-- there are malarial areas in South Africa, but if you are definitely NOT going to any of these, you don't need anti-malarials. Some doctors just make decisions by country rather by region and this can lead to overmedication. You might want to call the cardiologist again and be very specific about your itinerary, armed with the info that shows these areas are not malarial. That said, there IS still a very very very small risk that a malarial mosquito could travel (perhaps in a plane?), get to Joburg or Capetown and bite you. I met a man who had never been out of the northeast US in his life who contracted malaria somehow. Because no one suspected malaria it went on so long he got liver damage. They finally figured out that he had been working around the docks in Philadelphia, and a mosquito probably made the trip in on one of the ships! He was the only case.
So weird things can happen. Perhaps your cardiologist is just super-cautious--talk it over with him/her.

That said, if you do need to take an antimalarial, I think that your doctor's recommendation for malarone is a good one and probably the safest. It has very few side effects compared to the other options (most people have no side effects on malarone) and it is definitely more effective than doxycycline. It is far more common for people to get malaria while taking doxy than while taking malarone. (Not saying doxy is bad...I'm just saying that it is not as effective as malarone. If you have no health problems AND are religious about insect repellant and covering up at dusk, it is probably sufficient.)

In addition I completely disagree that "having an antibiotic in your system is a good thing". That is quite silly. Antibiotics DO (emphatically DO) have side effects (as other posters have noted...they kill of beneficial flora in the intestinal tract, and that can have longer ranging effects, including on your natural immunity to disease. AND having antibiotics in your system when you don't need them fosters resistant pathogens generally. I hope the docs who said this were kidding (and in fairness to them, it sounds like they might have been.)

Have a wonderful trip Joan!!
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Sep 25th, 2005, 11:45 PM
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Coincidentally, I watched a rerun on "Law & Order SVU" tonight which was about US soldiers who took malaria medicine & became psychotic. The prosecutor is going after the US Army for murder.
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Sep 26th, 2005, 06:22 AM
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Sunshine, check out the link in the post that started this thread. The Salon article is by the reporter who investigated and wrote the original news reports that provided the premise for this episode. The reporter says that the episode was accurate in its description ot the problems the US military experienced with lariam, but of course SVU made the reporter the bad guy, when in fact they led the charge in exposing the severe problems experienced with larium. The scary but true part is about the long-term effects the drug can have on the brain.
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Sep 26th, 2005, 07:43 AM
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Will do. Thanks!
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Oct 12th, 2005, 09:17 PM
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Would like to hear more about antimalarial drugs.

If we stay in Nairobi and Kigali - de we need preventative medicines like Lariam?
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Oct 13th, 2005, 05:00 AM
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Check the site for recommended Malaria meds.

You'll find mention of
-Malarone, the newest specifically for malaria and with least number of reported side-effect; maybe tummy problems if not taken with food, dairy preferrably, which usually disappear in a day or two. Protocol is to start taking these 2-days before entering infected area, daily and for 7-days thereafter. Cost is high at between $90-$125/person for the full number of pills needed (unless your insurance picks up some of the price.)

-Lariam - the one pill which this topic relates to. Has been shown for its side-effects of insomnia, wierd dreams, psychotic episodes, etc. though some people have none of these (small number don't); taken 1 tab a week starting 2-weeks prior arriving at infected area, then weekly (same day each week) and the 4-weeks after return. If availabile in generic, but cost will probably be $4-$9/pill, depending and whether your drug plan will pick up the cost.

-doxycycline - an antibiotic rather than specifically for malaris, recommended to those who for health reasons can't take the others. Has been reported that users have sun sensitivity so using an SPF on exposed skin is recommended, women can have thrush (discharge problems) and these have to be taken for 30-days after returning from infected area. Cost is the cheapest, but not necessarily the most effective.

Remember - these are just preventatives, not an inoculation. You'll have to remember to wear long pants, long sleeves and socks during mossie biting time - dusk to dawn, apply repellent on exposed skin (back of neck, hands).

But you must discuss your options with a professional - your personal physician who hopefully has a background in tropical diseases and knows your medical history or visit a Travel Clinic though prices here will be very high. With whomever you choose, go prepared with the cdc info and your questions so a proper script can be written.

Don't fool around when it comes to malaria - it's a nasty disease with over a million deaths a year.
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