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What is the general consensus on taking malaria meds long term: to do or not?!

What is the general consensus on taking malaria meds long term: to do or not?!

Mar 5th, 2008, 01:05 AM
  #1  
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What is the general consensus on taking malaria meds long term: to do or not?!

I will be living in Malawi for 9 months, where malaria exists everywhere. A lot of expats there don't take malaria meds, b/c they feel the side effects of the meds are potentially worse that catching malaria (which is commonplace for locals). A few expats do take the meds, for up to years at a time. I am totally torn as to whether to get the meds or not. I would love to hear feedback from people who live in malarial areas (with the understatement that of course I know I'm not getting professional advice here!).

thanks!
mp413 is offline  
Mar 5th, 2008, 02:28 AM
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Hi mp413

Without doubt I would seek professional medical advice from a medical travel specialist. But I do know that where I go in the Sabi Sands, near Kruger Park, the staff do not take malarial medication - I understand that you are not able to take it long term!

I am surprised to hear that people take it for years at a time - all the more reason to seek professional advice I think!

Kind regards

Kaye
KayeN is offline  
Mar 5th, 2008, 06:10 AM
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Absolutely, obtain professional advise for long-term use of malaria meds.

Most travelers to endemic areas spend maybe 2-3/weeks or a month, so for anytime longer (9/mo as you indicate), has to come for another source.

It's not at all unusual for people who live in malaria areas not take these on a long-term basis, even for life, but for sure, almost everyone will come down with malaria once or more often.

Yes, malaria can be treated, but it's a nasty disease and remains in your system; often having flare-ups even once out of the infected area, are not unusual.

I checked the package insert for Malarone and couldn't find info regarding how long patient can or shout take, so get thee to a professional.
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Mar 5th, 2008, 08:26 AM
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lbj
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An alternative that has served lots of camp staff well in the Luangwa/Malawi area. Beats screwing yourself by taking tablets. Doctors in the know should give you more than 2-3 months worth of malari tablets, especially malarone. It just messes with the body too much.

If you are rural and away from urbanised areas, the probability of contracting malaria is dramatically reduced. Hence why there is no real need for meds in the middle of the Okavango.
 
Mar 5th, 2008, 09:53 AM
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mp -

Speak to a professional.

Remember, there is no inoculation for malaria (which might be 99% effective), so we're left with meds that are a preventative. If you are taking these and do come down with malaria, supposedly it won't be as bad if not having taking meds.

In the middle of the Okavango with all that water is a perfect breeding ground for mosquitos.

Consult with a specialist in the field of tropical diseases in consideration of your own health history.


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Mar 5th, 2008, 11:00 AM
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lbj
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Sandi, I think you will find that the middle of the Okavango has low malarial risk. Just because mosquitos breed in the waters there, does not mean they carry malaria.

Humans are the hosts of the disease, mosquitos merely the carriers. As they have a flying range of around 2-3 miles, there is minimal threat. So out in the middle of the okavango, the probability is minimal. Having worked there, I know the implications.

If you work near a village or town, like Mfuwe, the risks are far higher. This is for someone living there, not visiting on a fleeting trip.

I would not continue using them for the duration of your stay. There are many dangers and not a lot of research has been given to the long term effects of things like malarone. Though any health care official may say different, as they could fear being sued.

Learn all the symptons, and if you are to take them for 2-3 months, do so during the rainy season.
 
Mar 5th, 2008, 01:49 PM
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Listen, up there in Malawi there are a few strains of Malaria that have become resistant to the drug, getting nailed by one of those blood suckers can kill you.

Take the prophylactics and don't take chances. If you do be certain that you know where the clinic is and that you have a vehicle that can get you there. If you do abstain, take at the very least a booster pack of quinine pills to fight the disease should you get it.
mkhonzo is offline  
Mar 8th, 2008, 01:14 PM
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I really appreciate the responses. The CDC says you can take doxycycline long-term with no side effects, which is what I was told by the person who prescribed me doxy last summer for a shorter trip to Malawi. (Malarone is too new to be known to be safe for long-term.) I still don't feel good about it, but I got the doxy anyway and have another week and a half to figure out what to do!

What kills me is that even taking this pill, every day, for 9 months, you can still get malaria! A friend of mine had to be off work for like 2 weeks from catching it, and he seemed very good about taking his meds every day. There just isn't a good solution!

thanks for the feedback though, it seems like my instinct not to want to take the meds for such a long time are not uncommon.
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Mar 9th, 2008, 04:46 AM
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Did the CDC advise that doxcy isn't specific for malaria.
- It's simply an antibiotic
- Women are susceptibe to thrush (discharge); do you need this when out in the bush?
- People who take tend to become sensitive to the sun... must always apply SPF
- Ask your physician what the long-term effects of doxcy - 9/mo daily is long-term.
- Malarone has been on the market almost 10/years, there should be some studies on its long-term use in infected areas.

sandi is offline  
Mar 9th, 2008, 07:28 AM
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Studies on the safety of long-long term Malarone use show no problems up to 9 months. Studies on each of the 2 drugs in Malarone alone (not in combination) show good safety for 2 years or longer -- so we suspect that the combination in Malarone can be used safely for more than 9 months, but it hasn't been documented. Doxycycline is fine (and popular given the availability and low price) for long term use. In addition to side effects previously mentioned, Doxy (like any antibiotic) can decrease the effectiveness of oral contraceptives...if that's an issue for you! (PS - I'm a nurse in a travel clinic)
skibumette is offline  
Mar 9th, 2008, 08:13 AM
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I took chloroquine and Paludrine for two years ending eighteen years ago. No problems then, and none now. A doctor I knew remarked that many of the supposed side effects -- trouble sleeping, problems with vision -- were in fact exactly what you might expect middle-aged people to experience with or without the medication.

I don't know if they are considered safe these days. I do know at the time it was considered safer to take them than to contract malaria. But don't rely on internet forum advice -- talk to a doctor.
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Mar 10th, 2008, 12:28 AM
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Thanks again, esp. skiburnette! I can't take chloroquine (Malawi is a resistant area) so it's Malarone or doxy for me (I ruled out Larium due to the horror stories). Like you said, doxy has the longest history, is prescribed for other things and is pretty common so seems safest. I can't afford Malarone anyway, but 10 yrs. doesn't seem long at all! I'm sure the U.S. FDA says it's fine, but other countries don't recommend Malarone use for more than 6 mos. I think it can cause severe renal damage too which is something I'd like to stay away from.

Skiburnette, if you don't mind my asking--I read that doxy only decreases effectiveness of certain types of pills, and that even so it's only for the first month that you start taking the doxy. (That's the Brit. govt.'s health website.) Does that sound right to you? I'm also curious if you've encountered people who don't want to take doxy for so long--are they generally advised to just take it?

Thanks again! I'm pretty sure I'm going to take the meds at this point, but this is all really interesting
mp413 is offline  
Mar 10th, 2008, 07:04 AM
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Antibiotics (including Doxy) potentially affect combination contraceptives, especially the low dose types. (Progesterone-only contraceptives are seemingly not an issue, so one option might be to switch to this type of contraceptive?)

I found one article citing several studies that showed the decrease of estradiols in the blood (while taking antibiotics) was minimal...and the "failure" rate (i.e. pregnancy) for antibiotics-takers was about the same as for women not taking antibiotics. But small consolation if you're the one affected? So it makes sense to try and minimize your risk of contraceptive failure...

I've read the British info and it seems reasonable, although "reduced flora in the gut" may not be the only mechanism affecting hormone levels.

Lots of people resist the idea of taking ANY medication long term. If it's any consolation, the anti-malaria dose of Doxy is the same as the amount taken by teenagers for several years for acne; sometimes the acne dose is even double this. But maybe you'll get clearer skin out of this too!
skibumette is offline  
Mar 13th, 2008, 02:46 PM
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mp413, a few years ago, DH & I lived outside of Pattaya, Thailand for 2 years and we both took malarial prophylactics while there. Neither of us had or have had any adverse effects from taking it.

I am not dispensing medical advise, but relating our experience.

Good luck.
llorear is offline  
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