malaria tablets good or bad

[Brian Lynch]

I planning my second trip to west Africa in January and i just want to rise a few questions related to malaria and different the forms of medication available for malaria and peoples different experience to those medications. Last year i was taking doxycydine and i was fine but i saw other people taking the same tablets who were getting sick. I have heard a lot of different stories related to taking malaria tablets and their actual ability to prevent the contraction of malaria, i would like to hear peoples experiences in Africa and what they think about medication for malaria..

[michi]

The first time I went to Africa, I went to a travel doctor to get all the necessary vaccinations and to put a travel medical kit together. He recommended Lariam for Malaria prophylaxis, which was the drug recommended by the WHO at the time. Lariam is not too expensive, and it is convenient: you only need to take a tablet once week, so there is less of a chance of missing a dose than with a drug that needs to be taken daily.

One thing I noticed while I was in Africa was that I had trouble sleeping. Not that I couldn't sleep, but I had these extremely vivid technicolor dreams. At the time, I put this down to the intensity of the experience. Everything in Africa was so new, so different, and so extreme that I figured my brain was doing overtime during the night trying to cope with it all and file it away in its proper place.

It was only after I had returned from that trip that someone said "What, you took Lariam? That stuff is hard-core!" My travel doctor never had mentioned any side effects. So, I started reading up about Lariam and found out that my experience was common, and that the side effects I had experienced were mild. In fact, for some people, they can be much more severe. From what I have read, some people even get psychotic episodes.

For my second trip to Africa, I saw the same doctor again and mentioned the side effects I had experienced and asked about alternatives to Lariam. He suggested Doxycycline. For most people, this drug has no side effects and, when they do occur, they are far less severe. Unfortunately, that drug is very expensive. For my two-month stay, I would have had to pay a little over $800 for the drug. After thinking about it, I decided to go with Lariam a second time, seeing that it hadn't done any permanent damage the previous time and that, on the whole, the side effects were tolerable for me.

The side effects the second time were the same: vivid dreams and unrestful sleep. During that trip, I made a firm decision to never take this drug again. Especially during the second month, I really got sick of the endless technicolor psychedelic dreams and of waking up tired in the morning.

So, if you can afford it, I would recommend Doxycycline. All the people I've spoken to who took it (many) said that they experienced no side effects of any kind. From what I've read, side effects are rare and mild when they do occur (except for a small fraction of people). If you do go with Lariam, I would watch out for side effects and, if they get too severe, discontinue the drug and replace it with something more benign.

Cheers,

Michi.

Edited to add: The alternate drug I mentioned is D_o_x_y_c_y_c_l_i_n_e.

I have asked for this in the past, and I'm asking for it again: can we please remove this ridiculous spam filter, at least for the body of messages? We have essentially no spam problem on this board, and that fact is not credit to the filter. I've run into the problems with this filter repeatedly in the past. For example, it recently nixed one of my rhythm notations, and I'm really sick of getting my posts mangled. This is not constructive!

[Marc_M]

I have asked for this in the past, and I'm asking for it again: can we please remove this ridiculous spam filter, at least for the body of messages?

Doesn't is seem ironic that by removing unwanted advertising we're helping to promote a brand of canned ham - can I say SPAM ! ! !

[bops]

The fact that it's being blocked by the spam filter can mean only one thing: that's some good shit.

You have to take anti-malarials. Not doing so would be very risky. The medication cannot prevent contraction of the disease, but they will reduce symptoms, if you do get it, and make it much easier to treat. All it takes is one bite. You should also be vigilant about using bug spray and a mosquito net (tent, whatever). It's a very serious disease that can be fatal. Not to scare anyone or anything...

The other option is called Malarone. It's a daily pill. I've taken it in the past and never had any issues or side effects that I recall. In the US, there may be a restriction (or recommendation) against prescribing it for over 30 days. This restriction has been lifted in Europe, and we talked our doc into prescribing it for us even though we're staying for 5 weeks.

I've never taken Lariam, but everyone who uses it has those crazy dreams. If you're prone to anxiety episodes, extreme mood swings, or have a family history of mental illness, that's not the medication for you.

More information here: http://www.lonelyplanet.com/thorntree/thread.jspa?threadID=1406975

[Marc_M]

Good information, folks. Thanks for posting. I'm definitely going to do my homework before heading to West Africa and look into the anti-malarials you have posted.

[rachelnguyen]

I took malarone the first time and it had no side effects at all. I am taking it again this time.

The issue with doxy is that it makes you light sensitive. Not good for us pale skin types.

About repellents: 3m makes one called UltraThon that is great. It is a lotion that comes in a ridiculously tiny tube (2 oz.) for a ridiculously large amount of money (about $10 each) but it was absolutely hands down the most effective of all the repellents we had. We spent some time in an area with a large number of mosquitos and the ultrathon worked very well and is a time released formula, so it lasts all day. Figure about a tube per person per week. For folks going in the dry season, maybe not as big an issue, but if you are planning to be there during the wet season, it is more of a big deal.

[Paul]

Best thing of all is to be religious about covering up, I always get bit on ankles or wrists or on lower back if your shirt is hanging out.. Always take clothes and shoes with you if you wont be back before night, a light neck scarf, socks, a light jumper to go over your t-shirt.. I think cities can sometimes be worse.

I always stayed in excess of 3 months so never took anything, but if I just had a month I would as you will be out of action for at least a week if you get it... Had it once it was nasty like a really bad flu and cerebral malaria is a killer..

[michi]

3m makes one called UltraThon that is great. It is a lotion that comes in a ridiculously tiny tube (2 oz.) for a ridiculously large amount of money (about $10 each) but it was absolutely hands down the most effective of all the repellents we had.

How well an insect repellent works depends on how much DEET it contains. The more DEET, the more effective the repellent.

Ultrathon comes in various concentrations. The strongest one contains 34.34% DEET. As you say, it's expensive.

There is a more effective alternative: Bushman Repellent. The strongest version contains 80% DEET. I've used this on many occasions, both in Africa and in the Australian bush. You will not get bitten when you use that repellent, period.

You can order via the website. (They do ship overseas.) 2.65 ounces cost $8.75. You can get a 1kg pump pack for $89.00, which is the equivalent of $5.05 for two ounces, half the price of Ultrathon, and with better protection.

BTW, if someone tries to sell you one of these ultrasound insect repellers (or any other chemical-free alternative), stay clear. These gadgets have all been shown to be snake oil.

Cheers,

Michi.

[rachelnguyen]

Hey Michi,

That stuff looks good.... and it is also a time release formula, which is really convenient.

[EvanP]

Went to REI today, and they carry Ben's 100% DEET (really 98+%) and one other brand. They were $7-$9 for 2 oz spray bottle. They also carry Bushman but I forgot to check the price, and it was not the large size.

Now that we've figured out what to apply, the question is how much is necessary per day/week? Can anyone comment on how much they used on their trip?

[michi]

Mosquitos get active late afternoon, around sunset, are really active at dusk, then keep going through the night and finish with another burst of activity throughout dawn. You are probably most vulnerable at dusk and through the evening, so I'd apply some late afternoon and maybe again around 9:00pm. I didn't use repellent through the night after showering because I slept with a mosquito net (highly recommended). I applied repellent again in the mornings, to see me through the early hours. During the day, I didn't bother because there were no mosquitos around.

As always, use common sense: if you notice mosquitos, put on some repellent.

Cheers,

Michi.

[Dugafola]

Went to REI today, and they carry Ben's 100% DEET (really 98+%) and one other brand. They were $7-$9 for 2 oz spray bottle. They also carry Bushman but I forgot to check the price, and it was not the large size.

Now that we've figured out what to apply, the question is how much is necessary per day/week? Can anyone comment on how much they used on their trip?

that stuff is no match for african mosquitoes IMO.

[michi]

that stuff is no match for african mosquitoes IMO.

You mean Ben's or Bushman's? Can you explain what you mean?

I've used Bushman's a lot and found that it works extremely well. Seeing that Ben's contains even more DEET, I would expect that to be slightly better than Bushman's.

Cheers,

Michi.

[EvanP]

I'm still wondering how much (volume) of any repellent is necessary for a 4-week stay? Does a 2 oz bottle last a week of 2/day applications to the neck, wrists, and ankles? Will it last all month?

While we're on the subject, do you treat clothes and socks with permethrin?

Here's what the CDC has to say:

Repellent Efficacy
Published data indicate that repellent efficacy and duration of protection vary considerably among products and among mosquito species. Product efficacy and duration of protection are also markedly affected by ambient temperature, level of activity, amount of perspiration, exposure to water, abrasive removal, and other factors. In general, higher concentrations of active ingredient provide longer duration of protection, regardless of the active ingredient. Products with <10% active ingredient may offer only limited protection, often 1–2 hours. Products that offer sustained-release or controlled-release (microencapsulated) formulations, even with lower active ingredient concentrations, may provide longer protection times. Studies suggest that concentrations of DEET above approximately 50% do not offer a marked increase in protection time against mosquitoes; DEET efficacy tends to plateau at a concentration of approximately 50%.

Recommendations are based on the summary of peer-reviewed journal articles and scientific studies and data submitted to regulatory agencies. People may experience some variation in protection from different products. Regardless of what product is used, if travelers start to get insect bites they should reapply the repellent according to the label instructions, try a different product, or, if possible, leave the area with biting insects.

Repellents should be purchased before traveling and can be found online or in hardware stores, drug stores, and supermarkets. A wider variety of repellents can be found in camping, sporting goods, and military surplus stores. When purchasing repellents overseas, look for the EPA-registered active ingredients on the product labels; some names of products available internationally have been specified in the list above.

Repellents and Sunscreen
Repellents that are applied according to label instructions may be used with sunscreen with no reduction in repellent activity; however, limited data show a one-third decrease in the sun protection factor (SPF) of sunscreens when DEET-containing insect repellents are used after a sunscreen is applied. Products that combine sunscreen and repellent are not recommended, because sunscreen may need to be reapplied more often and in larger amounts than needed for the repellent component to provide protection from biting insects. In general, the recommendation is to use separate products, applying sunscreen first and then applying the repellent.

Repellents and Insecticides for Use on Clothing
Clothing, hats, shoes, bed nets, mesh jackets, and camping gear can be treated with permethrin for added protection. Products such as Permanone and Sawyer permethrin are registered with EPA specifically for this use.

Permethrin is a highly effective insecticide-acaricide and repellent. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other biting and nuisance arthropods. Clothing and other items must be treated 24–48 hours in advance of travel to allow them to dry. As with all pesticides, follow the label instructions when using permethrin clothing treatments. Alternatively, clothing pretreated with permethrin is commercially available, marketed to consumers in the US as Insect Shield.

Permethrin-treated materials retain repellency or insecticidal activity after repeated laundering but should be retreated, as described on the product label, to provide continued protection. Clothing treated with the other repellent products described above (such as DEET) provides protection from biting arthropods but will not last through washing and will require more frequent reapplications.

Precautions when Using Insect Repellents
Travelers should take the following precautions:

•Apply repellents only to exposed skin or clothing, as directed on the product label.
•Do not use repellents under clothing.
•Never use repellents over cuts, wounds, or irritated skin.
•Do not apply repellents to eyes or mouth, and apply sparingly around ears.
•When using sprays, do not spray directly on face—spray on hands first and then apply to face.
•Wash hands after application to avoid accidental exposure to eyes. Children should not handle repellents. Instead, adults should apply repellents to their own hands first, and then gently spread on the child’s exposed skin. Avoid applying directly to children’s hands.
•Use just enough repellent to cover exposed skin or clothing. Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, apply a bit more.
•After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days.
•Wash treated clothing before wearing it again. This precaution may vary with different repellents—check the product label.

[rachelnguyen]

Hi Evan,

My experience of Bens was that it didn't work well in Mali. Even though it was 100% DEET, it didn't seem to work as well as Ultrathon. http://www.drugstore.com/ultrathon-insect-repellent-lotion/qxp203784?fromsrch=ultrathon. I have used ultrathon both times I was there and found it extremely effective. I took a 2oz tube for each week, per person. Drugstore.com has it for about $7 a tube, which is the best price I have found. I have not used the spray. The travel clinic recommended the lotion because it lasts for 12 hours. I admit, though, that I usually didn't put it on until just before dusk because I don't really care for the feeling of bug stuff.

As for permethrin, I bought the stuff and then didn't get a chance to actually apply it. I would say it couldn't hurt, but I haven't used it and was no worse for wear!