What to do incase of intestinal infection while on malaria meds

xtemp

First this is not a thread about if i can get malaria meds, which are best, or about side effects.

I guess you could say i'm extremely prone to tummy troubles. In my 5 1/2 months in Nepal i managed to get giardia 6 or 7 times, though thankfully I only had to deal with cholera once. This was despite filtering and treating all my own water. Now I'm headed to India for 7 months and will be on doxycyclin for Malaria.

My propensity for stomach trouble leads me to ask the following questions:

If I am sick how effective is an oral antimalarial going to be? Is there some strategy for taking it when sick so that it can still be absorbed?

Also, the treatment for giardia is an antibiotic. Given my prior history, I don't need a doctor to tell me when i'm suffering from giardia and i may be in places where getting to a doctor may be less than feasible. Given that doxycyclin is itself an antibiotic (though not a recommended treatment for giardia) what are the effects of adding an additional antibiotic like tinidazole? Is that generally recommended, or is that dangerous.

nayan

As far as I know giardia doesnot get cured in 2-3 day. It takes much longer. are you sure you have "giardia" so many times ?

I have some personal experience with a doctor in nepal who made a diagnosis of giardia(and several much more complicated diseases) for what turned out to be a simple case of hill diarhea.

In case you fall sick in india with tummy troubles and it does not seem to get better in 2-3 days, then please contact a doctor ASAP. I thought you will be travelling around mussoorie, jaipur etc. all this places have good access to doctors.

please donot self medicate... specially with antibiotics.

Baba

You intend to take Doxycyclin for 7 months?????

__________________
Baba

xtemp

each case of giardia lasted between 7-14 days depending on how quickly I began treatment.... and yes, that does mean that I was sick for more days than I was healthy while i was there. It is amazing how well you can get used to being sick when you have other things to do. The symptoms of giardia are rather distinctive, not at all like food poisoning or other forms diarrhea (which i also got, after awhile you really begin to appreciate the nuances ), certain things are just a dead giveaway. I spent a good deal of time in and out of various hospitals and clinics in Nepal with my kids and the Drs would give me some informal medical advice on the side(though to be clear, when i got cholera that was by no means an informal consultation ) the Drs seemed to think that self medication was perfectly legitimate for something as clear cut as Giardia. Still I can understand that it gets more hairy when dealing with additional factors (like malaria meds) and may be worth it to check out Drs...my concern about the lack of ability was more about those times before and after the programs in Jaipur and Mussoorie end and I have no idea where i'll end up.

As per the doxy: my doc gave the following instructions- start in mid february while in Jaipur which i would continue until 4 weeks after i'm in mussoorie (so through 1st week of june), then start again at the beginning of august (right before I leave mussoorie to travel to places unknown) and continue through 2nd week in september (4 weeks after I leave)... I think that works out to somewhere around 5 months

70s-80s overlander

Xtemp, you've asked some good questions.
(1) Given your track record with filtering and treating water, you might want to try boiling water [5 minutes] to kill giardia.
(2) Doxycycline has been mixed with Tinidazole -- so that is a known approach.
(3) Most meds go through the stomach lining into the blood in about 20-25 minutes, so if you keep the med down that long you probably have gotten the benefit; when in doubt, it would be OK to take another dose of doxycycline later in the day.
(4) Giardia does not always respond to single-agent or even double-agent treatment; that is, as soon as feasible you probably should find a hospital that has a good lab and a good physician.

Baba

Have you considered that taking antibiotics for such a long time will play havoc with the nice and helpful bugs in your system? Seems like an invitation for giardia and the like...
Here in Germany the consensus seems to be that for trips to India prophylaxis for Malaria is recommended only in special cases. They rather have you carry stand-by medication for when you do catch an infection.

xtemp

Thanks for the info! I actually don't think my filter treatment system was what failed me; I lived in an orphanage so my first guess would be contaminated plates...since there weren't enough plates to go around i ate in the second shift, which meant that the first plate was rinsed off in probably highly contaminated water and was not always dry before my food hit it...does that sound plausible?

I really appreciate the tips about doxy when sick, comforting to know I wont have to choose between medications.

Baba- That is my concern too. The doc told me to go on probiotics to help with this, but I'm still worried...I think one of the reasons i may have gotten sick so often in Nepal was that I got on this cycle where something made me ill, i took antibiotics, meaning lowered resistance to future illness, resulting in me getting sick etc...

Baba

As someone who's very likely to get any kind of intestinal trouble I feel for you. I had Giardia on two of my four India trips and so one of my goals is to stay off Antibiotics if I can. IMHO it takes months to get your system back to normal.