Malaria Pills - Do You Take Them in Thailand?
 

Travel doctors love prescribing malaria pills, which is of course good practice. But they aren't cheap, and I wonder whether they are as necessary as made to sound.

If mostly in Bangkok, doing a canal cruise and generally not roughing it - does it make sense?

Do you take the pills?

Cheers!

I've never taken Malaria pills for our six trips to Thailand. Bangkok, Chiang Mai and the beaches are not high malaria risk spots. To be sure of yourself, check the CDC website that lists high malarial risk locations.

protection is not needed in and around bkk. in some parts of thailand it is needed, like koh chang....

you should be fine but check with your doctor....my pills are paid for by my insurance with a $50 co-pay....better safe than sorry

Take a look at www.cdc.gov/travel. Also, do consult with your travel med doc about vaccines - things like Hep A and typhoid are recommended as well as updates of childhood vacines, if needed. All the info is on the cdc website.

There are only a few areas of Thailand often visited by travelers that are considered malarial risk: the Golden Triangle, Koh Chang (as Bob mentioned) and the border areas if you are traveling overland. There was a report on Thiorntree of a traveler who contracted malaria on the train ride to the Thai/Cambodian border.

@Kathie - thanks for the link. I was using some other websites.

Interestingly, my doctor didn't actually suggest typhoid, although her main area of knowledge is India. Luckily, I've got everything else already! (minus malaria)

An added note of interest - of the two available typhoid vaccines, only 50 to 80% of recipients will be covered, and then only for the strain S. typhi, not S. paratyphi. The 2 are not clinically distinguishable, and the latter is on the rise in SE Asia. Good fun.

It's true that the typhoid vaccine is not as effective as most other vaccines. Nonetheless, it is recommended fofr SE Asia as there are antibiotic resistant strains of typhoid there. Note that the oral vacine is good for 5 years protection, while the injection only lasts 2-3 years.

Typhoid, like Hep A is a food and water-borne illness. As we do not have control over the hand-washing habits of those who handle our food, I consider it a very valuable vaccine to have.

Fodorina, did your travel med doc recommend anti-malarials for your trip? I ask because in the US the cdc recommendations are considered the standard of care. If a doc recommended something contrary to the recommendations of the cdc I would be very concerned and would ask for peer-reviewed articles or other evidence supporting the recommendations.

There are for-profit travel med clinics that recommend all kinds of unnecessary things. The worst I've heard was a travel clinic in Australia that convinced a traveler that they needed Yellow fever vaccine to go to Thailand, though the US clinic who insisted the traveler to Chiang Mai must take anti-malarials and sold them Malarone at an outrageous price is certainly in the running.

I believe in practicing "defensive patienthood" (the counterpart to defensive medicine) so I recommend people print out the cdc pages for their destination and take them along to a travel med appointment. A good, competent provider will not be offended by this but will be glad to go over the recommendations with you and answer any questions you have.

When I was working I would load up on the vaccines because I was never quite sure which part of the world my company would be sending me to, so the "basics" were absolutely mandatory.

Then, with getting the plane tickets, I'd also get some information on what specifically was going on locally in the health area and get added protection, if necessary.

Like Bob, I believe in being safe than sorry.

On the other hand... if Dogster was Fodorina [and, with a nick like that, I'd like to be] I wouldn't fuss about malaria if staying in BKK doing the normal things.

I've been to BKK 12 times in the last 18 months.

That aside; Kathie's idea of 'defensive patienthood' is just great, eh?

You're right Dog, there is absolutely no reason to take anti-malarials in Bangkok, Chaing Mai, Chaing Rai, Phuket, Koh Samui, and most of the rest of the country. There are only very limited areas of Thailand that are malarial risk.

I hate malaria pills they make me dream bloody murder

debarks, you must be talking about Larium. There are a number of types of anti-malarials each with different side effects. Larium isn't effective in some parts of SE ASia, so most travel med docs don't recommend that drug for anywhere in SE Asia.

Is Malarone still drug of choice? Since I will be in both Laos and Burma I ain't taking no chances!!!!!

Don't you do dat Larium, NY - Dog will worry if you do. Scary monsters.

Nywoman, There are two effective anti-malarials for Laos and Burma: Malarone and Doxycycline. Malarone has the advantage that you only need to take it beginning one day before entering the malarial risk area, then daily, then for 7 days afterwards. Doxycycline you bin one day before, daily, then a full month after leaving the malarial risk area.

Malarone is my drug of choice for this area, but there may be individual reasons why someone may be better off with doxy.

malerone is also our one and only favorite...no side affects period...

Several trips to both Thailand, north and south and several Cambodia. Call us crazy and/or lucky, but for several reasons we decided against anything other than Typhoid, Hep A and Tetanus and lived to tell the tale. First travel doc we saw gave us all the standard recommendations and then said her biggest concern was complacency after she'd prescribed anti-malarials (which one will vary by when and where you go). This was because those nasty little bugs carry lots of diseases, some much more life-threatening than malaria. So, even if you take the meds, slather down with a strong solution of DEET.

bonnie, you are absolutely right, even if you do take anti-malarials (and especially if you don't) it's important to use an effective mosquito repellant. Dengue appears to have greater frequency in SE Asia than malaria right now, though that does vary.

Each person has to make the decision whether or not to take anti-malarials for themselves. But it is important that the decision be an informed decision, not just "I know someone who didn't take anti-malarials and they didn't get it." Good for you for getting a good consultation with a knowledgeable travel doc. By the way, it appears that Cambodia was likely the only place you visited that was malarial risk.

Being a layman in such matters I don’t normally comment on health matters, but I thought our recent experience might be of interest.

We have just been in one area which could have malaria and are off to another which certainly does. As some of you may know, there is a Malaria Research institute here in Chiang Mai and we contacted them. The advice from one of their doctors was:

“Don’t take depressants, they are site and type specific and therefore are not all effective in all places, they can have some nasty side effects and they can make one complacent.

Take precautions so as to not be bitten, repellent, long sleeves etc. and avoid the daytime mosquito as well, as it passes on dengue fever.

On return have a (for us free) blood test and if that shows positive for malaria a course of two injections will take care of it.”

The caveat to all this is that you have to have returned before the gestation period, if that is the right word, of malaria as once it develops treatment is more difficult. Therefore this is not appropriate advice if you are travelling for a long period or living in a malaria area.