There is just one other once a week pill and it is not effective in Africa.

I don't mean to prolong the conversation on this topic, but I just read the response from Kathie that because I am a health care provider I shouldn't advice people from taking preventative drugs.

I was NOT advice people/travellers not to take preventive drugs. I myself never have taken them, and I never will, but if anybody is interested about taking them, please discuss it throughouly with your doctor.

Here's why preventive drugs used is a PUBLIC HEALTH issues: several decades ago we rarely heard about drug resisitance strains of bacteria MRSA/VRE, drug resistant strains of Malaria and Tuberculosis, just to name a few. Now, these are common struggle for medical providers to deal with. It used to be easy to treat malaria with Quinine or Chloroquine, simple drugs of choice. Now, they like aspirin. Back in WWII Penicillin cured millions of all bacterial wound infections, and now, you rarely head anyone being treated with Penicillin for bacterial infection. Why? Because everyone wanted antibiotics from their doctor everytime they have common cold or flu, URI(Upper Respiratory Infection). All of which no treatment needed. Soon, we are running out of drugs to deal with all these new strains of parasites. My point is, once these bugs are mutated and resisted to all these new drugs, which in the recent WHO health report it's already developed into such population), the side-effects from taking them outweight their benefits.

And that's, in my opinion, is A SERIOUS PUBLIC HEALTH ISSUES.

Why, you asked, there are still advises for travellers to take these drugs. I am not sure. Perhaps, it has something to do with a question such as, why the drug rep(pharmaceutical company) sponsoring health care professionals to a golf trip-continuing-education program every year, say somewhere in exotic places like Hawii resorts?

Again, it's just a penny of my thought.

Hi Kathie - from the websites you have suggested people refer to for advice on malaria and jabs, I think you are in the US and speaking from a US perspective. I am in the UK (although previously lived in the US) and I think that this may account for some of the differences in information being posted here. I think it is therefore inappropriate to speak of misinformation in these circumstances.

The specialists I have seen here in respect of various long term trips to highly malarial areas in Africa have not, despite the fact that UK licensing laws would allow them to to prescribe for longer periods than 3 months, done so. Although, I would add that the outer (UK licensed) time limits are much less than the 'years' you cited as being appropriate for usage of doxy and larium - I believe Larium for 1 year max and Doxy for 6 months.

I prefer the more cautious approach of the specialist practitioner that the organisations that I have worked with have referred me to than time limits that I feel may have been pushed to extremes by research studies funded by companies with a vested interest in long licensing periods.

I think that we need to accept that different countries will have different licensing periods and different medical practitioners within those countries may have lower limits in practice that they are comfortable with.

For those with questions about malaria, I think everyone has agreed that independent medical advice from a specialist or general practitioners should be sought.

On reflection, it is highly inappropriate for any of us to advise on what drugs should be taken on this forum - perhaps we shouldn't even be stating what we do in similar circumstances.

Bayon - I really agree with your views expressed in your last post. It is a grave concern.

http://www.who.int/mediacentre/facts.../en/index.html

For those who cares, click the link above, read and judge for yourself.

Whoa! We have too many topics going here - no wonder there are misunderstandings.

It is true that I am from the US and that I use the cdc website frequenty. The WHO website is certainly a very reputable site, but they do not update their malarial maps frequently (no doubt a budget issue). When I want to check on malarial risk areas, I typically check both sites and look for most recent updates.

Here are the issues I was concerned about:

1. Bayon posted two things I thought were not accurate: "Washing hands and use DEED [DEET] bug spray, are much more effective and safer than those [anti-malarial] drugs." Hand-washing, while always wise, is not an effective prevention for malaria. While not taking drugs to prevent malaria means that one would not have side-effects, repellants alone are not as effective as the combination of repellants and anti-malarials. While one might make the decision to not take anti-malarials, and that is an individual decision, I believe it is important to give accurate information on a public board such as this.

2. In the same post, Bayon writes: "hand washing alone would eliminate most of the GI problems, including the Hepatitis A" As i responded in my earlier post, hand-washing (along with other standard food and water precautions) is a good prevention for many GI problems. However, Hep A is transmitted primarily in poor sanitation and handwashing by the people preparing and handling the food you are buying. This happens not only in developing countries but in developed countries as well. It is hard for me to imagine why a health care professional would discourage people from getting the Hep A vaccine, which has very long term effectiveness.

3. Bella, I agree with most of your comments, and certainly respect what appears to be a conscious and infromed choice not to take anti-malarials in SE Asia. As you know, only limited areas of SE Asia are malarial risk. However, I do disagree with your statement about anti-malarials not being appropaiate for long term use. Volunteer workers from the US do typically take anti-malarials for longer periods, often two years (Peace Corps workers in malarial risk areas typically take the appropriate anti-malarial for a full two year period.) There is good data on these groups. Also, Doxycycline was (and still is) use for intractable acne in the US, and adloscents often take it for two or three year periods. WHile I respect differences in practice among practitioners, I am simply advocating for the posting of accurate info as possible. Wheterh prescribing long-term anti-malarials is more cautious or less cautions is a matter of perspective.

4. Bayon - You posted quite a bit about antibiotic resistance. The citation from WHO from 2001 is a good one. The over-prescription of antibiotics and patients not completing the full course of antibiotics for for an infection has contributed to antibiotuc resistant strains of many bacteris. This, however, is not especially relevnt to the topic of anti-malarial drugs. Only one anti-malarial medication (doxycycline) is also an antibiotic. Interestingly, despite the fact that doxy has been used effectively as an anti-malarial for many years, there has never been any documented malarial resistance to doxy.

I believe that one must be an informed consumer of medical care to get the best care. I advocate that people read the cdc website (or the WHO website) prior to consulting with a travel medicine specialist.

http://www.tulane.edu/~dmsander/WWW/...esistance.html

The quote below is a short version of the link above.

"It is clear that imported malaria cases will continue to be a problem for the foreseeable future, as the mobility of tourists and workers is increasing all the time, and non-immune individuals are bound to find themselves at risk. The common prophylactic drugs are, for many areas, obsolete (19), and the use of advanced drugs such as artemisnin derivatives for uncontrolled prophylaxis would be downright irresponsible given the obvious ability of Plasmodium falciparum to attain a high degree of resistance in a short period. It has already been suggested that strains resistant to Artemisnins will appear by the end of the decade (16), and this does seem inevitable."

http://www.tulane.edu/~dmsander/WWW/...Treatment.html

Just another quote to entertain folk.

"The use of drugs such as mefloquine and chloroquine in the prophylactic role appears somewhat questionable, given the deteriorating global resistance situation, and the NHS no longer prescribes prophylactic antimalarials. Perhaps insecticide impregnated mosquito nets and insect repellent creams are the best prophylaxis for a traveller, especially due to the problems of unpleasant side effects and non compliance. Indeed, it seems that the initial widespread prophylactic use of the now outdated antimalarials was responsible for the rise of resistance in the first place (19). This is a cautionary indicator for how we use our new drugs such as artemisnins in the field. It seems that many travellers still take antimalarials in the prophylactic role, however."

Bayon, because of the mobility of travelers it is important to use prophylactic medications. I was unable to get your links to work, but I wonder when and (where) this was written, as there are interesting errors in terms of what we know today. There has been widespread chloroquinine resistance in many areas of Asia, Africa and some parts of central/South America for decades. There is mefloquine resistance in small parts of Africa and SE Asia. The quote you give seems to indicate that these two are the only common prophalactic drugs, which is simply not true.

There has not been any demonstrated malarial resistance to either Doxycycline or to Malarone anywhere in the world.

Artemisnins are used for treatment only, so the quote about using them prophylacticly is curious.

Bayon, I was finally able to get your link to work. I note that this is an article out of a textbook from 1996. The options for treating malaria have changed substantially since then.

During the Rwandan crisis in Republic of Congo(formerly known as Zaire) I had spent a year working in the region(Rwanda, Zaire, Urganda, Burundi, Tanzania, and Kenya). Even then, 1994-1995, Lariam has shown sigfinificiant resistant in the large population. Initially, Medicin San Frontier (Doctor Without Border) protocol called for Quinine and Chloroquine, but they got very limited results. Later, Lariam and combination drugs treatment was implemented.

Similar situation is presently existed in Cambodia, Vietnam, and Lao(perhaps Thailand too). Even though, the UN had spent Billions of dollars since the early 90s in the region, esp. Cambodia. In my humble opinion, things are getting worse, regarding health concern, than getting better. Mutated microbial strains will never revert back themselves, as far as the genetics concern.

Can't help but throw my two cents in based on profession and personal experience. I have degree Public Health and Epidemiology, and I just got back from trips to east Africa, Cambodia, Vietnam, and Bangkok.

First go to www.cdc.gov.

This website has the most up to date info about outbreaks and hotspots, and can give you info specific to the areas you will be travelling in in Thailand.

Second, take Malaria pills. One of the people in our group in Africa missed her pills a day or two, and ended up with Malaria. Definitely not fun. She got treatment early, but was still completely knocked of her feet for days, so I can't imagine what it would be like it you don't happen to get treatment earlier. Even if you get treatment early, please recognize it is not just like having the flu.

The majority of our group took Malarone. As long as you take it with food, you are unlikely to have problems. No side effects reported by the 10 people on Malarone.
I have heard reports of a laxative effect, but sometimes that is actually due to eating or drinking contaminated food or water.

Talking with our guides, Malarone seems to have the fewest problems. Lariam can cause psychiatric problems, dizziness, fogginess, etc., and sometimes were severe enough that people had to be sent home. Doxy is another option. However, in the warm moist climate that is southeast Asia, women may be more likely to develop yeast infections.

We still got bit by mosquitos even though we used 50% DEET products and long sleeve etc in the evenings. The problem is they are unpredictable. You can have no problems for days, and then hit one small area or day, and the mosquitos are everywhere and are biting.

Hope this helps

Better safe than sorry.

Just for the record - I had the "laxative effect" from Malerone and had not even arrived at my destination (still on the plane) - so you can rule that theory out.

While Malarone didn't have a laxative effect on me, it did upset my stomach and since I also started taking it before arriving at my destination, I think it's far morely likely that it was caused by the medication itself and not any contaminated food or water.

Craig,
Please note I said SOMETIMES the laxative effect can be due to dietary changes or contaminated food. It is also suggested that Malarone be taken with food to reduce likehood of stomach problems, but it make not completely knock them out. Yes, there are always side effects to taking any drug, however my main purpose for making these statements is to try to impart that malaria is far worse than most of the side effects of any of the malaria drugs (although Lariam can have signficant pyschiatric problems in certain indivduals), and that the majority of people won't experience problems of any real consequence. It is important to find that best fit for each individual. The CDC website spells out the contraindications and best uses for each of these drugs, and a good travel clinic will be up on these as well.

By no means was a trying to discount any one individual's reaction to the anti-malarials, rather wanting people to focus on the likelihood of having side effects, and to contrast that to the effects that malaria could have