Leaving for Vietnam, Bangkok, Siem Reap & Hong Kong mid January. Visited travel clinic and got script for Malarone. Also given scripts for Azthromycin (Zithromax) for upper respiratory infection, and Rifaximin (Xifaxan) for travelers diarrhea. Did anyone use either of these meds while traveling in these areas and did they work?

Only Thailand and Cambodia are on the Center for Disease Control's list of countries for Malaria risk. However, Bangkok, Chiang Mai, Chiang Rai and Phuket are NOT a Malaria area, only limited border areas in the north of Thailand are on the list. There is no risk in Hong Kong or Vietnam. On that basis, whether you want to take malaria meds which have their own side effects and are not 100% effective is up to you. You will have to use bug spray in any event, as Malaria meds are not effective at all against Dengue fever, which is present in many of those places (including some cases even in Hong Kong, but of course its 50 degrees here today and will be even colder in mid-January so the risk of any mosquitoes being alive are rare). It also appears that the drug recommended by your clinic is NOT the correct drug of choice for Thailand or Cambodia, I would refer you to the cdc.gov website. You may want to go another doctor for the correct drug. You also need to start taking the pills now before the trip for them to have any prophalatic effect.

I don't understand a clinic prescribing antibiotics without first testing you; this IMO is a clinic that wants your money and does not really care about your health, nor the worldwide problem with superbugs and antibiotic-resistant infections. The fact that they prescribed the wrong malaria meds, and for countries that the CDC does not even have on their list of countries with a malaria risk tells me something. I would not take an antibiotic for a "chest infection" unless I knew that I indeed had a chest infection and what strain of infection I had. For diarrhea, I would take Imodium or Pepto Bismol. There are lots of good bugs in your gut that you want to keep alive, you don't want to kill them off by taking an antibiotic at the first sign of a "stomach upset" which may be nothing more than a reaction to more green chilies in the curry than you are used to. Youghurt works well too to keep the good bacteria going and take out the bad.


For ALL these places, you should have Hepatitis A and B shots and for many you should have a polio booster and a rabies booster. A typhoid shot is a good idea too. If your travel clinic did not recommend those, I would definitely get another clinic, as they don't know what they are doing. You should not worry so much about the exotic diseases, and you should worry more about the pedestrian ones.

Cicerone,

What do you mean by "Wrong Malaria Meds"? I was under the impression that Malarone was the drug of choice for Siem Reap? Not so? I leave in 13 days and was told Malarone.

I just looked at the cdc.gove website and they are not listing Malarone for Cambodia, they are listing other specific meds for different areas of Cambodia; I am guessing this is because of resistance to meds in specific areas. That is all I know. You might want to discuss this with a doctor who knows travel medicine.

Only the border areas of Thailand (borders with Cambodia, Laos and Burma) are malarial risk areas. Most of Cambodia is malarial risk, and part of VN is also malarial risk. Malarone is recommended for all of the malarious areas in SE Asia for prevention, as there has been no documented resistance to malarone anywhere in the world. (Cicerone, you must have missed it, as Malarone is definitely listed on the cdc website as an anti-malarial for Cambodia.) Note that there is resistance to Larium in Cambodia, and virtually all of SE Asia has chlorquinine resistance, so the only two effective anti-malarials for this region are malarone and doxycycline.

Cicerone, I know you don't agree with travel med docs prescribing antibiotics for traverls to take along in case they need something, but it is routinely done in the US for persons visiting third world countries. The traveler should have clear guidelines as to when the antibiotics should (and should not) be used, as well as a recommendation to seek medical help if they do need to use antibiotics and symptoms do not subside.

MSheinberg, you have been prescribed the correct anti-malarial.

Hopefully, you will not have to use the antibiotics prescribed. In more than 20 years of traveling, I have used my travel antibiotics only once - and that was in the US!

Sorry, yes I se that Malarone is the brand name for atovaquone/proguani. For Vietnam, there is no Malaria risk in risk in Hanoi, Ho Chi Minh City (Saigon), Da Nang, Nha Trang, Qui Nhon, and Haiphong. For the average tourist on the average tourist itinerary for SE Asia, other than Ankor Wat, they simply are not going to be in Malaria areas. Moreover, I still don't see the point in taking them in the dry season and when you will be using bug spray to prevent Dengue anyway.

I really don't see the point in taking antibiotics that one does not need. That is just stupid in my view and also leads to problems for others when they DO need antibiotics to work. It has nothing to do with "Americans being prescribed antibiotics for travel to third world countries." This happens everywhere. In Hong Kong and Singapore, doctors routinely prescribe antibiotics for colds. That drives me even crazier. It has more to do with doctors wanting to get patients out of their offices, wanting some money, and patients thinking that a pill will "cure" them (the placebo effect runs strong).

Cicerone, there is not the big difference in malaria transmission rates between wet season and dry season in SE Asia as there is in India and parts of Africa. Thus, antimalarials are recommended in the risk areas of SE Asia year around.

There certainly are other malarial risk areas in SE Asia in addition to Siem Reap that are frequented by travelers:

In VN, the greatest risk area is in the Mekong delta, a place often visited by those who go to HCMC. And many rural areas, especially in the sounthern part of the country are malarial risk.

All the rest of Cambodia (other than PP) is malarial risk, and Laos (other than Vientienne) and Burma (other than Rangoon) is all considered malarial risk.

In Thailand, the area most often visited by travelers that is malarial risk is the Golden Triangle area. But those going overland to Siem Reap, for instance, travel through risk areas while still in Thailand.

Of course, travelers should also do what they can to prevent mosquito bites such as using a deet based repellant as ther are other diseases spread by mosquitoes, notably dengue, but also JE.

Interesting comment about India in the dry season. Malarone makes me slightly quesy, though not anything I can't deal with, but just wondering if I should take the risk of not taking it for February in Rajasthan -- though I will be going to Varanasi, which I understand has a thriving mosquito population.

Kathie, I disagree on the "risk" in Thailand in the Golden Triangle, only because I am quoting from the CDC website which says that only areas in the northern border areas are a risk, and not Chiang Mai or Chiang Rai, which are IN the "Golden Triangle". The typical tourist does not travel overland between Cambodia or Laos and Thailand, at least not the ones on this board. They fly to Siem Reap and Luang Prabang. Longer-term backpacker travelers staying in non-air-conditioned hotels tend to go overland, and for those travelers I would say they should consider anti-malarial. For the typical 2-week traveler to Thailand who reads this board, and is staying in an air-con hotel (which tends to really cut down on the mozzies which are most active at dawn and dusk), really the risk is so low that IMO the side affects of taking the anti-malarial is not worth it.

For Vietnam, again I was quoting from the CDC website. They may not be the be-all of info, and again they give info for rates of disease which may not be at all relevant for tourists. They give rates of the disease for the entire populations, and I personally don't think they are at all relevant for tourists. They are relevant for locals living in conditions that expose them much, much more frequently to conditions in which they are likely to contract Malaria.

For a typical tourist traveler, IMO it is much more important that they have an updated Tetanus, as they are more likely to encounter a rusty nail somewhere, than a Malarial mosquito.

CFW in Feb in Varanasi and elsewhere in northern India you will be wearing a sweater and long pants most of the time, certainly in the mornings on the river and in the evenings. You may even have gloves on. It will be quite cool to cold, esp when the sun is down. You may be able to discard the sweater in the afternoon in the sunshine. The water level is generally quite low in Varanasi on the river then, and of course it is the dry season. The chances of your being bitten I would say are quite low. Again, for India I think that Polio an updated Tetanus and Hep A and B are more important.

Regardless of how you interpret the malaria info in the above posts, one should have Tetnus, Hep A and B and Typhoid shots. Don't skip preventing the ordinary risks. Also, note that in BKK, Bumrugard Hospital is a very good facility and has been used by a number of posters on this forum.

Cicerone, a couple of points: First, Chiang Mai and Chiang Rai are not considered to be in the Golden Triangle. The Golden Triangle is the relatively small area in the far north of Thailand that shares borders with Burma and Laos... you can see both countries from the Golden Triangle area. As such they qualify as border areas are are clearly delineated as malarial risk (not just by the cdc, but by the UK NHS and WHO). You are correct that Chiang Mai and Chiang Rai are not malarial risk.

No question, most travelers to Thailand are not in malarial risk areas. But those who choose to visit the Golden Traingle are in a risk area. And those who visit Siem Reap or Luang Prabang are in malarial risk areas.

While not many people on this board travel overland to Cambodia or Laos, some do. There was a recently (in the last year) reported case of a traveler on this board who took the train to the border to cross into Cambodia and picked up malaria apparently on the train.

As far as VN is concerned, here is what the cdc has to say about risk areas: "Rural only, except no risk in the Red River delta and the coastal plain north of the Nha Trang. No risk in Hanoi, Ho Chi Minh City (Saigon), Da Nang, Nha Trang, Qui Nhon, and Haiphong." All those not listed are considered malarial risk. As I mentioend in a previous post, the area most visited my travelers to VN that is malarial risk is the Mekong Delta.

Travelers to all malarial risk areas do decrease their chances of acquiring malarial by exercising precautions against mosquito bites. Staying in an air-conditioned room is helpful, but we have all stayed in air conditioned rooms that have mosquitoes, so it is certainly no guarantee.

Population statistics for locals are useful, but do not reflect the danger for visitors who have no immunity bulit up over time, and therefore are more susceptible to malaria.

Recommending that one take precautions against malaria in malarial risk areas in no way takes away from the importance of travelers vaccines. One should have tetanus vaccine just to stay at home, and one is well advised to have the Hep A vaccine even if one is not traveling. Typhoid vaccine is advised in SE Asia, as is an up-to date MMR (measles, mumps, rubella) and polio is advised for those who have not had a polio vaccine as an adult.

In additon to educating oneself about about disease risks by reading the cdc or nhs or toher travel med website, one should always seek the advise of a travel med specialist. Let me note that indeed, the OP did so and received appropriate anti-malarials.

While no one should depend on medical information posted on a forum for their care, I do believe that those who have medical knowledge have a responsibility to correct misinformation posted.

Cicerone, I consider you an expert in travel to Hong Kong and India, but your responses to questions about travel medicine have not been accurate.

CFW, within the last year, the NHS has changed some of their recommendations about anti-malarial medications for India. There is still some contraversy about this. Some areas of India are considered malarial risk year around, others are not.

I would consult with my travel med specialist about this.