Travel health advice: Antimalarial drugs – friend or foe?

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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?

About Malaria

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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).

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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.

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  • 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

 

With roots in Bavaria, a home in England and a heart in Scandinavia I've always been a restless soul. My first true adventure began as a six month voyage around South East Asia as a fresh faced backpacker and ever since I've lived a semi nomadic existence, clocking up over 35 countries on trips and living in both Dublin and Australia. I'm a lover of US Road Trips, deserted beaches bathed in warm glow of a sunset, Cuban mojitos, easy-on-the-eye travel destinations away from the crowds and all things Scandinavian - from cloudberry liquors to Scandi Noirs. When not travelling, you'll find me walking my rescue dog in leafy South West London, wandering the Brighton Laines on random day trips, hunting around for photogenic landscapes or daydreaming about returning to my all time favourite places in the world - Havana, Copenhagen, Italy, Iceland, Thailand and the frozen landscapes of a wintry Iceland. Follow Becky on Twitter and Google+.

11 Comments

  • Dr Felix

    4 February, 2016 at 12:55 pm

    People really need to consult their GP as part of their travel plans. Sorry to hear about your bad experience. malarone is quite expensive which can put people off from being prepared with malaria tablets, more awareness is needed about generic and cheaper meds like doxycycline which can achieve the same thing dependent on your allergies and location of course.

    Reply
  • Karen

    29 January, 2015 at 2:27 pm

    If travelling to a new country for the first time, you should be sure to consult with your doctor about the treatments and medicine for malaria. It’s such a shame you had those nasty symptoms. I’ve heard good feedback from Malarone products – however they are quite effective and can be found cheaper through private prescriptions here in the UK!

    Reply
  • Vicki Brown

    17 August, 2013 at 6:00 pm

    Thank you do much for this article. I took Doxycycline and developed very painful hand and foot blisters and also discoloured and tender fingernails. I am to return to India April 2014 and need to consider how best to protect myself without these painful and long lasting side effects
    Vicki brown

    Reply
  • Kim

    21 February, 2012 at 12:34 pm

    In regards to Lariam, it was perhaps foolish of this person to not seek specialised advice from a travel doctor. I am lucky enough to be able to take Lariam side effect free, but the travel doctor warned me in advance of all of the potential side effects and also that they take three weeks (doses) to appear. Thus, he suggested beginning the Lariam a month before my trip, and then I knew I was fine before I had even left home. I was with about 10 other people who took Doxy, and whilst a few experienced worse sunburn than usual, almost everyone was happy to put up with it. We were in Africa for between 6 weeks and 3 months and for a short term trip, who wants to come home with malaria?

    Reply
  • Eli

    14 June, 2010 at 9:07 pm

    Sounds to me like there are no easy solutions to this problem. Those side effects sounds pretty nasty, and the costs are indeed a major factor especially for spending prolonged amounts of time in malarial zones. You’ve left me with a lot to consider.

    I was actually looking at mosquito nets earlier today, what’s a good brand recommendation?

    Reply
  • Karin

    14 June, 2010 at 4:47 am

    Thanks for the good advice, very timely for me as I’ve just arrived in India and about to go to the pharmacy to buy antimalarials. I’ve also used doxy before and suffered nasty stomach cramps which meant I had to stop taking it, now I know also to stay clear on Lariam. I don’t think they sell Malarone in India so think I will go for Chloroquine plus proguanil, even though I know there is some resistance.

    Reply

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