Anti-malarials in India

4gotoIndia

Hi there,
Given the number of times people ask the same questions about malaria, I thought I’d compile the information. Perhaps it can be made into a sticky? Any corrections welcome!
4

First of all, this is not ADVICE about which anti-malarials to take in India. You should seek medical advice, and take into consideration which parts of India you are going to and the season.

Meanwhile, here is a summary of some of the main things that might be useful to know.

Bed nets – widely available in ‘bedding stores’, cheap but they are the most basic ones and may not pack up small. If you want a ‘stand-alone’, bring it with you

Insect repellent – Odomos, widely available in chemists. 12% Deet. If you want anything stronger bring it from home.

Paludrine/ Proguanil . Taken daily, in combination with chloroquine. May be available in India, but not easily.

Chloroquine. Taken weekly, usually in combination with paludrine. Available in India.

Doxycycline. An antibiotic taken daily. Widely and cheaply available in India. Possible side-effects include sensitivity to the sun and yeast infections. Cannot be taken by children under 12.

Larium / Mefloquine. Weekly. May be available in India, but not easily. Possible psychological side-effects.

Malarone. Taken daily. Not available in India. Expensive.

There is lots of information available online. For example
WHO: http://www.who.int/ith/chapter_7_2008.pdf

Map of India:
http://www.fitfortravel.scot.nhs.uk/...maps/india.htm


Information from CDC: http://wwwn.cdc.gov/travel/destinationIndia.aspx

For long-term travellers:
http://www.hpa.org.uk/cdph/issues/CD...3)p200-208.pdf

edwardseco

A fine job indeed IMHO. For Doxy heed the instructions on how to take it (I am prone to esophogitis so doubly important)..

SFtoBLR

Great timing - I am researching this as we speak! All of the malaria meds available are a bit scary to us, as we'd be taking them for over a year. But then, so is malaria! I've found self testing kits are available, and maybe the best solution for us - skip the prophy meds, but be able treat right away if positive.

Any idea on the availability of these tests in India as a whole, Bangalore in particular?

wonderwomanusa

I suspect having the test done at a clinic in Bangalore might be approximately the same price (or less) than the cost of a self-test here.

Nick-H

Forget the self-testing kits!

You'll find both a doc and a lab not too many minutes from where-ever you are in a city.

Why on earth would you want to self-test? It just is not worth the risk.

Malaria: Self-diagnosis, self medication: just say No!

(this has been a public service announcement.........)

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SFtoBLR

From what I've read so far the test are quite accurate, and I loathe the thought of running to the doc for a temp. I have reached that time of life where running temps and the sweats are pretty common, very early I hasten to add : )

Mostly I am concerned about traveling outside of India - SE Asia and Africa in particular, though I realize we'd likely be back in B'lore before symptoms begin. If it was just my husband and I I wouldn't worry very much, but my daughter, (will be) 14 will be there the whole time, and my son, 16, will be visiting for at least a week or two. I'm a card carrying weenie mom/mama bear when it comes to them. Also, my son and I are quite tasty to mossies!

BTW, I am assuming that treated bed nets are available in B'lore cheap - here they are at least $55. If not, please let me know, and I'll break dowon and buy a couple.

Nick-H

I'd still advise against the self-test. I can be pretty ill with the flu, and I too am not at all inclined to run to a doc while I feel I can look after myself, and hey, flu's a virus and what can they do anyway?

But twice in the past three years I've been for the test, and the most recent time it was strongly suspected, so the doc started me on anti-malarials anyway, immediately. They are supposed to do more than one test if there is any doubt whatsoever, and it is critical that they identify falciparum (I think that's the one) because that (or whichever it is) can affect the brain, and you can be dead in a week.

That's why I really strongly recommend the professional approach.

By the way, I was negative both times

(But next time it is strongly suspected I'll actually probably just go to hospital, because the drugs just made me much more ill, and I'm told that can be avoided by intra-venous delivery --- we live and learn!)

edwardseco

Actually there seems some doubts on the non-commercial sites. I know its not FDA approved. My biggest concern would be carefully doing such while desperately ill. Mucked up a pregnancy test and for a second opinion took my spouse to a doc who promptly told me the correct info..

grikoo

First, as I have pointed out before, most indian strains of malaria are chloroquine resistant, so this is not a reasonable prophylactic for India (actually very few places in the world). Check the CDC if you doubt this.

Self medication for malaria is STUPID (sorry, had to be said). You need to go to a doctor anytime you have severe flu-like symptoms and get tested. The dosages required to treat malaria WILL cause side effects. For example, the dose of mefloquine necessary for treatment is 5 times that of the prophylactic dose. My girlfriend was unable to form proper sentences, write, and had obvious discoordination when she doubled the dose. I have no doubt that at 5 times the dose, she'd at least be a drooling idiot, and would definitely need to be watched for complications. With any treatment dose of any of the anti-malarials, you need medical supervision.

Not taking any prophylactic is also not too smart, especially if you're going to be in India during the wet season, or longer than a month or so. It's a deadly disease and can be very difficult to get rid of once you get it. The falciparum strain can kill you before you even figure out you have malaria.

The only instances where you might consider self treatment would be if you suspect malaria and are more than 24 hours away from a doctor. In those instances, I'd recommend taking doxycycline (assuming you're not already taking it) 100-150mg, twice daily WITH FOOD, but only until you get to a doctor. Normally you would take quinine sulfate with doxy as a treatment, but the doxy by itself should help "control" the infection until you can get to a doctor for proper treatment. Most of the other treatments will lay you out and may interfere with your ability to even get to a doctor.

If one is absolutely hell bent on self treatment, malarone is probably the best, safest and most tolerable. Dosage is 4 tablets once daily for 3-4 days. Dose can be split and taken twice daily if gastrointestinal side effects are too pronounced.

grikoo

Here's a table showing chloroquine resistant areas.

Attached Thumbnails

 

machadinha

That final HPA pdf link botched up. (As did the FitForTravel one btw, I think you meant this one http://www.fitfortravel.scot.nhs.uk/...maps/india.htm .) Can you post it again?

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4gotoIndia

Here is the cdc one again. Hope it works this time

http://www.hpa.org.uk/cdph/issues/CD...3)p200-208.pdf

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machadinha

Thanks, worked this time Lengthy, but probably useful to prospective long-timers. Note:

grikoo

By the way, here's a useful tidbit of info-

With the majority of drugs taken over time (i.e. not a single dose treatment), the drug dosage can generally be split in order to reduce side effects. To do this, take the normal dosage and period and divide it by two. In other words, if you're taking 250mg mefloquine once a week, you could take 125mg twice a week and would likely avoid some of the side effects. This is particularly true of drugs like antibiotics, where a specific amount of the drug is maintained in the bloodstream.

Normal dosages are figured based on the half-life of the drug, and because of this, splitting the dose actually better maintains the desired amount of the drug. For example, mefloquine, which has a half-life around fifteen days, needs to be taken at least once a week in order to maintain the proper amount of the drug. But taking it twice a week only better maintains that level, and should make the side effects less pronounced (though possibly more consistent).

Doxycycline has a half life of about 24 hours, which is why you need to take it daily, but if you had problems with it, you could very well take half the dose twice daily to maintain the same levels.

It's widely applicable and something to remember if you have side effects from any drug. Just make sure you're not changing the dose/period ratio.

federica

Then I am really curious why Germany doesn't advise Malaria prophylaxis for India anymore except for two states... as far as I know the risk of falciparum is less than 50% in India... and most of the travellers who come back with Malaria suffer from Plasmodium vivax.

Regarding P. vivax, prophylactic medication can suppress only the first fever, but not the reocurring fever after months, so it is almost useless for this strain, if not more dangerous as people think "Oh, I took medication, it can't be Malaria".