You’re about to travel to a known malarial zone; you’ve read the literature, you know the statistics, you even know the range of drugs on offer that will protect you from contracting the disease. But have you explored all the other alternative options and are you fully aware of the potentially very unpleasant side-effects from these drugs?
Malaria is a mosquito-borne infectious disease and is widespread in tropical and subtropical regions, including parts of the Americas, Asia and Africa. It’s a disease with very unpleasant symptoms and can be fatal. The symptoms include fever and headaches and in severe cases coma and death. Modern drugs are normally prescribed as part of the preventative measure and these drugs include mefloquin (Lariam), doxycyline (available generically), and the combination of atovaquone and proguanil hydrochloride (Malarone).
I recently spent three months travelling through Africa and almost everyone was taking one of these recommended drugs and almost everyone felt some form of side-effect, mostly not reported in the literature we were provided. One of my fellow travellers even experienced some very serious side effects on the antimalarial Lariam. He was not informed by his GP that Lariam is known to sometimes cause severe depression, anxiety, paranoia, nightmares, birth defects and central nervous system problems (occurring in up to 25% of people taking the drug). In certain cases the symptoms of the side effects are permanent.
While photosensitivity is a recognised side-effect of Doxycycline, I personally experienced painful, discoloured fingernails and toenails on this drug that resulted in me discontinuing with the course, even while travelling through known malarial zones. Photo-onycholysis refers the separation of the nail plate from the nail bed after exposure to ultraviolet light and can be induced by doxycycline. It’s not a well publicised side-effect but one I had the painful experience of finding out for myself!
The use of prophylactic drugs is also seldom practical for travellers spending extended periods of time in malaria-endemic areas. This is due to the cost of purchasing the drugs (which can be very expensive) and the negative effects sometimes experienced from long-term use.
So what other options are out there?
- Artemisinin is a drug used to treat multi-drug resistant strains of falciparum malaria. Use of the drug by itself is explicitly discouraged by the World Health Organisation as there have been signs that malarial parasites are developing resistance to the drug. Combination therapies that include artemisinin (such as Coartem or Cotexin (SP)) are the preferred treatment (not prevention) for malaria and are both effective and well tolerated in patients.
- Prevention. Mosquito nets used mostly at night above a sleeping area help keep mosquitoes away and greatly reduce the infection and transmission of malaria. Insect repellents containing DEET will also protect against mosquito bites. As a general rule, a 5% product will provide approximately 90 minutes of protection while 100% provides up to 10 hours. It is also advisable to cover up as much as possible in malarial zones and to wear long sleeves tops and long trousers.
If you are making a trip to a known malarial zone hopefully knowing the facts will help you make some informed choices-and remember prevention is always better than cure!
All words by Camille Brandon