Malaria

mikefairbairn

I was wondering if anybody has any recommendations for which antimalarial to take?

As India has malaria resistant to chloriquine would it be effective to take chloriquine combined with proguanil? (Brand names Paludrine or Savarine)

I am not to keen to take Larium if it can be helped, as I have read about the dangers.

Has anyone used doxycycline?

Finally how bad is the Mosquito situation in and around New Delhi in November?

Cheers, Mike

abracax

I took doxycyline during my last two trips, and the contrast with Lariam was substantial. I hardly attacked anyone.

__________________
He travels fastest who pays for a cab.

maree

I took Doxy for about 2 weeks in the Amazon last year. One of the side effects is sun sensitivity. By the time I reached Pakistan and India I had a really itchy red rash on my arms.....which lasted for about 6 months.....and which itched the whole time - it drove me mental. I was popping anti-histamine tablets constantly. Did try some ayurvedic remedies too but they didn't seem to work. I'll never take Doxy again. It doesn't effect everyone like that but I did meet another person who had the same reaction. I didn't take anything for malaria in India - had met a US med student who was working for 6 months in Kerala and he said that the chances of us getting malaria were remote as now it's pretty much confined to very remote rural areas (I think that's what he said). So I just used repellent and hung a mosquito net when I felt the need.

abracax

Yes, it is an antibiotic so that's something to bear in mind with doxycycline. It's also true that you don't need to take it unless you're in a danger area. For instance on my last trip I only took it for about three weeks out of the 14. But as for malaria only being in the remote areas, don't bet on it. The places I was worried about last time were Bangalore, Chennai and Delhi, each of which was going through an epidemic of cerebral malaria at the time. Simple biology: more people, more mosquitos, more chance of infection. The advantage of doxycycline is that it's a daily regimen, so you can start and stop easily, not like the circulation-loading quinine-based drugs.

paan wallah

high

i m very scared about taking malaria pills...
only reading the sideeffects makes me more sick than maybe malaria itself
i once took palandrine and got very sick from these pills...
i also tried doxy and Ieven got more sick
from it...
iI think the best thing is to use a good mosquito net..
stay healthy eat good food and vitamins...
but every body reacts different on these pills...
my body for example doesn t like antibiotics very much...
some years ago I had an outbreak of thypoid fever in india...
that time I was glad that I took some vaccination against it before..
so I only had some smaller problems with it...
also I wouldn t recommend taking malaria pills for long term travellers...

eat good food and try to stay healthy!

mikefairbairn

Cheers for the replies guys,

Most interesting indeed,

I think I am going to take chloriquine combined with proguanil? (Brand names Paludrine or Savarine), has anyone had experience with these?

cheers Mike

abracax

Chloroquine and Lariam are very similar, except chloroquine doesn't work anymore. I hereby retire from the malaria debate, since it has become a ridiculous morasse populated by people who don't pay attention, and those who think vitamins can actually affect parasites that enter your blood stream.

-m2-

I don't want to get into this very far either, but will add a comment or two anyway.

The nights are quite cool in Delhi in November, you are unlikely to encounter many mosquitoes, let alone ones bearing malaria.

Taking drugs unnecessaraliy is foolish -- particularly ones that many people have serious side effects with. Like Maree, I have met doctors working in tropical areas and asked how they protected themselves and what they would advise and invariably the comment was 'save the meds for treatment, if there are mosquitoes around (in the evening, when the nasty ones are out), cover up, use a repellant, and sleep with a net.

The worst advice comes from home country 'public health nurses' who generally have *no* travel experience whatsoever and rely on UN publications recommending various things for various areas. Conservative general advice, but not necessarily useful in specific situations.

Bring along something (never heard of proguanil) if it makes you feel better, but suggest you save it until you learn that you are in, or going to, a particular problem area. Cerebral malaria is not to be taken lightly -- if you will be passing through an area where it is problem (the Delhi newspapers will certainly be reporting any localized epidemics), then by all means start taking an appropriate prophylactic before going there and continue for a week or two afterwards. Local advice as to what is effective for the immediate problem will be the best, and the appropriate drugs should be available from local pharmacies for much less than you will find at home.

just my 2cents worth, but I have spent many winters in India and SE Asia without problems.

mike

Alan D

This is one of the most discussed topics by travellers to India and there is a lot of info and opinions on this site and others. Have you done a search on indiamike.com? If not, just click on search and type in 'malaria'.

Just a few personal details. I travelled through Asia extensively during the 60's and early 70's without taking anti-malarial medication. I was lucky and didn't get malaria, yet a friend did. Returning to India in the mid-90's I took anti-malarials for the first 2 trips but found myself having stomach problems, which I attributed, rightly or wrongly, to this medication. On later visits to India I only took medication (on the advice of an Indian Prof of Medicine at a Delhi hospital) when travelling in a high risk area like Assam. I backed this up with using a mosquito net where there were mosquitos around and sometimes using an anti-mosquito cream or spray, and covering up arms and legs around dusk.

I still, like most travellers to India, have not got malaria but I think there is also an element of luck involved. I don't want to get into a discussion about which is the most effective anti-malarial on the market but suggest instead that you read up on the subject and make your own choice. There is plenty of info on the web.

traveler

Malerone was recommended by my travel clinic instead of Larium due to some health problems I was having at the time. A few weeks later I read an article about it in a travel magazine, saying it was now preferred over Larium for effectiveness. I also found it on the web:
New combination provides better protection for prevention of malaria. The newly released combination of atovaquone and proguanil (Malerone) was found to more effective in preventing malarial infection than the combination of chloroquine and proguanil. In addition, patients taking the new combination experienced fewer side effects (particularly gastrointestinal). Lancet 356:1864 (2000). (December 11,2000)
My husband and I took it for 2 trips last year, 4 weeks and 6 weeks in duration, and had no side effects. The only drawback is having to take it every day, but we think it was worth it. You may want to give it a try.

tlotoxl

I used doxycycline and am still on it since I just returned from India. I didn't really experience any increased sun sensitivity or any other discomfort and what's more I didn't have a single zit the whole time I was there (tetracyclines are used for acne, so that's not really surprising).

chloroqomide

CHLOROQUINE / pronoguanil RUINED MY LIFE!!!!!!!!!!!!!!!!!!!!!!!
I took chloroquine in a substanbtial dosage for 5 months: 2 pills a week. unfortunately for me the leaflet issued with them as well as by the doctors independantly, warned of seizures fits and changes in mood, which in my opinion is a mask for panic attacks, mania, depression, and psychosis. in a precarious situation these can ruin a life. i have gone downwards ever since i came back, partly due to the appalling state of the medical services in the uk. I still intend to make a full recovery, but from 18-24 has been certainly marred by a traumatic i"spontaneous?!?" influence on my psychefrom those 5 months. all the after effects were characteristic of post traumatic stress disorder. The slowly wearing lack of sleep that they can entail brings on a mental exhaustion, at 18 and inexperienced, i was soon having appalling panic attacks and agoraphobia and depression that i kept hidden somehow and that were clinical for 3 years. now i just look meek. The doctors prescribed me drugs afterwards (and i felt i had no choice) that had bad effects on my liver and concentration.
My body and mind have been in a very bad way for 5 years now, i'm highly active but possibly not innately headstrong. in my eyes these drugs bring on schizotypal effects, and can ruin a life if you are very unfortunate. the companies hide the information.

chloroqomide

I still need to find someone who knows anything about developments with these drugs, i've never found anyone to liaise with and my doctors (mr bean chracters often) downplay and pay no attention to any mention of chloroquine adverse effects. please help me out if you know some contacts or people who have similair experiences. zplazm@yahoo.com thx

qualo

last time i took doxy- no side effects. this time i'm up north so won't take any unless in a high risk area. a good strong repelent should be enough. hopefully.

mikefairbairn

Well, I'm back home safe and sound....I took Savarine (chloroquine and proguanil) for a month in India, have about two weeks left on it and so far have had no side effects.

My perspective on this controversial subject......I'm glad I took an anti-malarial, just for piece of mind, when you land in Bombay and they tell you that malaria is raging, I was glad of having took it.

However I do have doubts over the effectiveness of Chloroquine and proguanil.....I probably would take doxycycline if I was going back.

In saying all of this, I didn't find the mosquitos bad at all in Oct/Nov. I took some coils to burn and burnt a few in the nights, and had repellant which I used in the evenings and didn't get many bites at all, probably about 5 in total in a month. We didn't have a mosquito net and only used one that was supplied in Goa.

Overall I found the mosquitos to be buzzing around alot, but kind of innocuous, not at all like some of the killer varieties I encountered in South America, that would bite through clothes etc.

Well thats my two cents worth, take a few precautions and I think you'll be fine.