Using Doxycycline and Malarone in combination

cosmic-unity · Mar 28th, 2007, 08:09

Due to the complicated nature of my journey in and out of many Malaria risk areas throughout the world, I will need to be on doxycycline for several months on end. Also due to the very expensive malarone treatmeant, this is rather unpratical to be on that alone either.

What I plan on doing is taking doxycycline during the period I spend in a risk area, and as soon as I leave, take a course of Malarone (starting one day before I leave) for 7 days INSTEAD of taking doxycycline for 4 weeks (also start malarone one day b4 I stop the doxy). This reduces my required doxycyline intake by 3 weeks, and also may dampen the side effects of being on anti-biotics constantly for months on end.

My travel doctor advised against this due to both medication affecting the maralia parasite at different life stages. I just would like a second opinion on this.

Thanks

goangoangone · Mar 28th, 2007, 09:15

I would rather listen to the doctor.

nedhopkins · Mar 28th, 2007, 12:58

Very, very bad idea.

But if you want reassurance via a second opinion, see another doctor.

old india hand · Mar 28th, 2007, 13:02

Just Doxy will do - no problem.

goangoangone · Mar 28th, 2007, 13:34

Additionally, doxy is used to treat many conditions including acne over a long period without any major side effects. The most likely is increased skin sensitivity to the sun. This is not a problem unless you want to lie on a sunbed all day.

edwardseco · Mar 28th, 2007, 13:51

Doxy can be a problem in the sun sensitivity if you are fair skinned. It affects me in the first week or so I am in India. Afterwards its great if taken according to instructions. The doctor sounds like he knew what he was talking about..

Dr. Gajaprishthakara · Mar 28th, 2007, 14:36

I think that you need to take into account that, to prevent malaria, you take doxycycline 1 to 2 days before you travel to an area where malaria is present, daily while you are in the area, and daily for 4 weeks after you leave the area. I think that sort of runs contrary to your intentions.

I am not in any position to comment on the wisdom or otherwise of juggling the two drugs (apart from to point out above that you may have already dropped the balls).

If your doctor is expert in this area, take her/his advice. Otherwise find another doctor. At least you are not one of those (surprisingly numerous) poor bugger travelers who are taking chloroquin (without realising that it has no effect on the strain of malaria prevalent here).

Additional information available at
http://www.cdc.gov/travel/regionalmalaria/indianrg.htm

Good luck and safe traveling.

cyberhippie · Mar 28th, 2007, 14:56

The Chloroquine and proguanil combination, is what most travelers use and is perfectly ok for India unless travelling in certain areas in the North East of the country!

Lots of people make the mistake of seeing that there are Chloroquine resistant strains of Malaria, then jump to the next step that this renders the drug completely useless. NOT TRUE
It's is still good for all other strains of Malaria and used in combination with proguanil, it is a perfectly safe preventative for India!
(Apart from the special areas in the North East)

Proguanil on it's own isn't licensed in America, so the combination never appears on American sites, like CDC.

To the OP I suggest talking to a doctor about the overlap time between the two regimes. Though I think doxy is good enough throughout the world for Malarial prevention!

Dr. Gajaprishthakara · Mar 28th, 2007, 15:06

ok - my understanding is different. Because there is resistance building up, people are advised NOT to use it. Apart from anything else - it increases the speed of mutation. Cyber, maybe you could provide a link to a reputable site to support what you are saying as this is such a serious issue.

cyberhippie · Mar 28th, 2007, 15:19

The WHO recommend this treatment, as do many European health agencies

Net doctor UK

HPA

The Malaria site

Nick-H · Mar 28th, 2007, 15:25

I was advised by a local doc in my own area of Chennai to take only Chloroquine.

But I say this only to illustrate how the doctors in the area will know what kind of malaria is present and what it is resistant to.

cyberhippie · Mar 28th, 2007, 15:37

I think the treatment of Malaria using chloroquine is the bigger issue anyway. However if you're moving around the extra insurance of proguanil is definitely a good thing!!

Nick was that Chloroquine phosphate he was offering I was wondering what they were for?

Dr. Gajaprishthakara · Mar 28th, 2007, 15:39

Well, this is not exactly layman friendly but:

From WHO

QUOTE

[Removed by poster who can't read and is waiting for new glasses - apologies]
UNQUOTE

I think it is important to argue this one out so that IM can provide accurate information (THAT DOES NOT REPLACE THE ADVICE OF YOUR MEDICAL SPECIALIST). Maybe if we can get top an agreed best practice answer, consideration may be given to removing some of the more confusing posts.

cyberhippie · Mar 28th, 2007, 15:44

The above is talking about treatment not prevention!

Wormwood is as yet not an anti malarial (hopefully it will be one day)

If your looking for definitive answers on this subject, good luck!! I've been looking into malaria prevention for years and it very muddied water I can tell you. New guidelines from the UK have further confused the issue!

Dr. Gajaprishthakara · Mar 28th, 2007, 15:50

apologies - sorry - reading in a rush - will delete

Mar 28th, 2007, 08:09	#1
cosmic-unity Member Join Date: Jun 2006 Location: New Zealand Posts: 11	Using Doxycycline and Malarone in combination Due to the complicated nature of my journey in and out of many Malaria risk areas throughout the world, I will need to be on doxycycline for several months on end. Also due to the very expensive malarone treatmeant, this is rather unpratical to be on that alone either. What I plan on doing is taking doxycycline during the period I spend in a risk area, and as soon as I leave, take a course of Malarone (starting one day before I leave) for 7 days INSTEAD of taking doxycycline for 4 weeks (also start malarone one day b4 I stop the doxy). This reduces my required doxycyline intake by 3 weeks, and also may dampen the side effects of being on anti-biotics constantly for months on end. My travel doctor advised against this due to both medication affecting the maralia parasite at different life stages. I just would like a second opinion on this. Thanks

Mar 28th, 2007, 09:15	#2
goangoangone Monsoon Loon Join Date: Aug 2004 Location: Goa Posts: 1,535	I would rather listen to the doctor. __________________ GoanGoan......here

Mar 28th, 2007, 14:36	#7
Dr. Gajaprishthakara Senior Member Join Date: Mar 2007 Location: Sydney, Melbourne, Cairo, South India Posts: 360	I think that you need to take into account that, to prevent malaria, you take doxycycline 1 to 2 days before you travel to an area where malaria is present, daily while you are in the area, and daily for 4 weeks after you leave the area. I think that sort of runs contrary to your intentions. I am not in any position to comment on the wisdom or otherwise of juggling the two drugs (apart from to point out above that you may have already dropped the balls). If your doctor is expert in this area, take her/his advice. Otherwise find another doctor. At least you are not one of those (surprisingly numerous) poor bugger travelers who are taking chloroquin (without realising that it has no effect on the strain of malaria prevalent here). Additional information available at http://www.cdc.gov/travel/regionalmalaria/indianrg.htm Good luck and safe traveling. Last edited by Dr. Gajaprishthakara : Mar 28th, 2007 at 14:37. Reason: speelingk

Mar 28th, 2007, 15:25	#11
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 27,692	I was advised by a local doc in my own area of Chennai to take only Chloroquine. But I say this only to illustrate how the doctors in the area will know what kind of malaria is present and what it is resistant to. __________________ . Just one member of the IndiaMike Mod Team

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Mar 28th, 2007, 12:58	#3
nedhopkins Senior Member Join Date: Jul 2004 Location: California Posts: 231	Very, very bad idea. But if you want reassurance via a second opinion, see another doctor.

Mar 28th, 2007, 13:02	#4
old india hand Senior Member Join Date: Jun 2004 Location: Australia Posts: 105	Just Doxy will do - no problem.

Mar 28th, 2007, 13:34	#5
goangoangone Monsoon Loon Join Date: Aug 2004 Location: Goa Posts: 1,535	Additionally, doxy is used to treat many conditions including acne over a long period without any major side effects. The most likely is increased skin sensitivity to the sun. This is not a problem unless you want to lie on a sunbed all day.

Mar 28th, 2007, 13:51	#6
edwardseco Maha Guru Member Join Date: Sep 2001 Location: Land that shakes and bakes. Posts: 4,141	Doxy can be a problem in the sun sensitivity if you are fair skinned. It affects me in the first week or so I am in India. Afterwards its great if taken according to instructions. The doctor sounds like he knew what he was talking about..

Mar 28th, 2007, 14:56	#8
cyberhippie Account Closed by User's Request Join Date: Jul 2002 Location: the Netherlands Posts: 6,012	The Chloroquine and proguanil combination, is what most travelers use and is perfectly ok for India unless travelling in certain areas in the North East of the country! Lots of people make the mistake of seeing that there are Chloroquine resistant strains of Malaria, then jump to the next step that this renders the drug completely useless. NOT TRUE It's is still good for all other strains of Malaria and used in combination with proguanil, it is a perfectly safe preventative for India! (Apart from the special areas in the North East) Proguanil on it's own isn't licensed in America, so the combination never appears on American sites, like CDC. To the OP I suggest talking to a doctor about the overlap time between the two regimes. Though I think doxy is good enough throughout the world for Malarial prevention!

Mar 28th, 2007, 15:06	#9
Dr. Gajaprishthakara Senior Member Join Date: Mar 2007 Location: Sydney, Melbourne, Cairo, South India Posts: 360	ok - my understanding is different. Because there is resistance building up, people are advised NOT to use it. Apart from anything else - it increases the speed of mutation. Cyber, maybe you could provide a link to a reputable site to support what you are saying as this is such a serious issue.

Mar 28th, 2007, 15:19	#10
cyberhippie Account Closed by User's Request Join Date: Jul 2002 Location: the Netherlands Posts: 6,012	The WHO recommend this treatment, as do many European health agencies Net doctor UK HPA The Malaria site

Mar 28th, 2007, 15:37	#12
cyberhippie Account Closed by User's Request Join Date: Jul 2002 Location: the Netherlands Posts: 6,012	I think the treatment of Malaria using chloroquine is the bigger issue anyway. However if you're moving around the extra insurance of proguanil is definitely a good thing!! Nick was that Chloroquine phosphate he was offering I was wondering what they were for?

Mar 28th, 2007, 15:39	#13
Dr. Gajaprishthakara Senior Member Join Date: Mar 2007 Location: Sydney, Melbourne, Cairo, South India Posts: 360	Well, this is not exactly layman friendly but: From WHO QUOTE [Removed by poster who can't read and is waiting for new glasses - apologies] UNQUOTE I think it is important to argue this one out so that IM can provide accurate information (THAT DOES NOT REPLACE THE ADVICE OF YOUR MEDICAL SPECIALIST). Maybe if we can get top an agreed best practice answer, consideration may be given to removing some of the more confusing posts.

Mar 28th, 2007, 15:44	#14
cyberhippie Account Closed by User's Request Join Date: Jul 2002 Location: the Netherlands Posts: 6,012	The above is talking about treatment not prevention! Wormwood is as yet not an anti malarial (hopefully it will be one day) If your looking for definitive answers on this subject, good luck!! I've been looking into malaria prevention for years and it very muddied water I can tell you. New guidelines from the UK have further confused the issue!

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Dr. Gajaprishthakara Senior Member Join Date: Mar 2007 Location: Sydney, Melbourne, Cairo, South India Posts: 360	apologies - sorry - reading in a rush - will delete