Anti-malarials in India

SFtoBLR

All very interesting, if not ultimately more confusing!!

I do not advocate self tx for myself or anyone else for any serious issue. The self testing idea is more about not freaking whenever I have a temp, as I have one almost all the time these days, and a fear of the prophys available. Believe me, a temp w/other symptoms, a temp that goes over 100, or a positive test result would have me at an MD right quick!

For us anyway, there doesn't seem to be a clear cut easy choice. Serious concerns about the meds available are due to our medical histories. My kids both took Doxy for acne and both had to stop after their fingernails began detaching from their fingers from the top down, not to mention the heightened sun sensitivity, and doxy seems the most benign of the bunch. My son, daughter and I all have depression, so Larium is out. There is an apparently resistance to the other meds available in much of Asia and switching around whenever we take a weekend trip just doesn't seem practical. Malarone seems safe, and is probably what we'll go with if we decide to take prophy for the full time there, but there haven't been many long term studies and apparently it's not widely available in Asia, so factor in the hassle and cost of shipping it over every couple of months.

I am open to any suggestions, taking account of the above, as I really am not all THAT stupid and well realize the risk malaria poses to us. If anyone has one I'd be glad to hear it.

grikoo

Theoretically, prophylaxis interferes with the parasites ability to take hold in your body, so isn't exactly 'supressing' the disease itself, but rather keeps you from getting it initially. However, you are right in that many of the treatment methods are incapable of completely eradicating the parasites from the liver, which is why the disease is so hard to cure and tends to recur. Prophylactics kill the parasite before it's able to take up residence in your liver. This is exactly why you should, rather than why you shouldn't, take a prophylactic.

50% or 10%, falciparum is very very bad. You don't want it. And I'd assume you don't want vivax either, though perhaps it's a matter of personal taste.

Couldn't guess why Germany doesn't suggest malaria prophylaxis. It's odd if you ask me.

machadinha

Probably because in many countries (of origin, for travelers) and depending on what precise destination, the emphasis seems to have been shifting for quite some time now from prophylaxes to prevention and treatment. I'm guessing malaria's rapid adaptation and consequent resistance to prophylaxes also figures into it, so there is now more concern about feeding that cycle unnecessarily. I suppose knowledge of specific risk areas vs. entire countries also keeps increasing.

Germany (first time I heard of it for that country) isn't the only country to be reported to have shifted its course on this.

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chaia

My Dr. prescribed me Malarone for emergencys as treatment (if there's no Dr. around) and then see a Dr. as fast as possible. But no prophylaxes.
Wouldn't want to take something for 5 month anyway

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grikoo

Actually, I believe Federica may be right after all. It appears after some additional reading that the P. ovale and P. vivax life cycle goes like this: the parasites are injected, then go to your liver, then infect your red blood cells, which causes malaria symptoms. As doxy and mefloquine work only in the red blood cells, the liver phase remains unchecked. P. falciparum and P. malariae lack a dormant liver form, and are controlled by the normal prophylactics. Still, falciparum is the most deadly strain, and even if it's only a 50/50 chance of getting it, it seems prudent to take a prophylactic.

Malarone and primaquine work in the liver, so work on that part of the cycle as well. Primaquine seems to be the only drug that can remove the dormant parasites. This drug requires a G6PD enzyme test, so don't even think about self treatment.

machadinha

Has this been answered yet? I think I've heard they're not widely available in India at all no. I believe you can treat them yourself however.

I may well be wrong on both counts; mostly just bumping this in the hope that someone else will answer.

As the original poster noted too:

grikoo

I'm not aware of the treated nets being available.

You can get the permethrin treatments easily in the EU and US, and they're cheap. Some companies even give them away with the purchase of a net.

If in India, you might try an agricultural, pesticide, or veterinary supply company for the permethrin. It should be incredibly cheap for a lifetime supply, and is one of the most common insecticides. It's cheap even in the US at about $30 a quart for the commercial ultra concentrate grade (which would last forever), but you need a pesticide applicators permit in most states. Don't know the regulation status in Europe. The other option is a veterinary soak, like this one: http://www.amazon.com/Permethrin-10%.../dp/B00061MSS0

My understanding is that the chemical naturally bonds extremely well to most fibers, so worst case you can get a can of bug spray (containing permethrin of course), but these are often scented.

I'd want to verify that the permethrin treatments used for clothes aren't using an additional binder before I used an insecticide grade chemical by itself on clothing, and so far haven't been able to track down that info. Wouldn't want huge amounts of insectides soaking into my skin, even though permethrin is fairly safe, relatively speaking.

And since we've been talking so much about prophylactics, I think we may have lost track of the most important factor- The best prophylactic is obviously not getting bitten.

Nick-H

[quote=SFtoBLR;488343]Believe me, a temp w/other symptoms, a temp that goes over 100, or a positive test result would have me at an MD right quick! [quote] 103 is my limit! At that point I feel so damned ill I start needing re-assurance.

Eeeeeeaaaarrrrgghhh!

Even if I felt I was the most balanced example of mental health in the world I'd still be reluctant!

Have you considered the old-fashioned (but I think still recommended for India in UK) combination of Proguinal (sp?) and Chloraquine? Only the former is hard to find in India.

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grikoo

If you still have records, you might look at the dosage they were taking. The recommended children's dose for prophylaxis is 2mg/kg, up to a max of 100mg daily. If they were taking more than that dose, you might reconsider it.

While it works better than chloroquine by itself, I'm not aware of any references that recommend chloroquine +proguanil for prophylaxis in chloroquine resistant areas. Are you?

edwardseco

Second hand, I have been told they are available in Delhi..

Nick-H

See the HPA Malaria guidlines, particularly the table on p44.

Note that there is an update here recommending proguanil and Chloroquine for visitors to North Goa, and remarking on the number of visitors returning from there to the UK with malaria.

The only really really dodgy , in terms of likelihood of malaria and chloroquine resistance combined, otherwise, according to this Brit source, would seem to be Assam. I read an article on the local authority's fight against malaria in Assam recently here.

I also read in the local news a week or so ago that Malaria is spiralling (dizz mossies?) in the Andamans.

by the way... Nets are fairly easily obtainable here, but treated nets (mentioned in the Assam article too) I have not seen here.

grikoo

Odd.... For a different take, you could visit the www.cdc.gov site, which only recommends doxy, mefloquine, or malarone, and confirms chloroquine resistence.

The HPA site acknowledges the 'widespread' occurence of chloroquine resistent falciparum, so it's strange that they'd suggest chloroquine +proguanil as a prophylactic.

federica

It's strange that there are so many different advices from different countries...

Nick-H

Yes... absolute disagreement between CDC and HPA on Chloraquine!

edwardseco

Keeps us busy here. But, it does point out the abysmal state of research on this important topic..