Guys,

Who "knows" if Doxycycline (sp?)is an effective preventative against Malaria?

JW

I've been taking it for about 6 months a year for the last 4 or 5 years or so and so far, haven't had malaria........ Thank God! - I'd strongly advise you to take a daily dose of acidophilis to guard against thrush as well though. I'd also advise you take it in the evenings and not in the mornings to minimise the sun tan effect.

Malarone is also good although expensive. As far as Larium is concerned, I don't take it because of the side effects, although they don't seem to affect everyone.

quote:

Originally posted by Jeff Wemmer:
Guys,

Who "knows" if Doxycycline (sp?)is an effective preventative against Malaria?

JW

It is, without a doubt. It has been proven to work in large studies.

Wes

Whoa!

Doxy only keeps you from getting symptoms. You still need to take another antibiotic when you get home for 2 weeks to 8 weeks (depending on the product) to kill the Malaria in your liver.

I got Malaria in Vietnam in 2002. I took Doxy during the duration of my trip, but never took the follow on drug as it made me feel wierd.

About a month after getting home I developed Malaria symptoms while on leave in Casper, Wyoming. At least Casper has a specialized disease center for such things. Your own community may or may not have one.

I wish I remember what I was issued to kill off the Malaria.

Wyoming Medical Center used a double shot of Boxicillin and Bicillin or something like that.

Needless to say it's pretty rough! I advise you do your home work. There are a lot of tropical medicine docters in America, but not everyone will have one.

I ended up calling my flight surgeon at the base where I was stationed at his home and having him talk to the local Casper doc. The flight doc had spent 8 months in Brazil and 10 months in Benin on a Navy tropical medicine deal.

Malarone seems to be widely recommended by international medicine guys. I took it without side eefects and NO hypersensitivity to sunlight. yes, it costs a little more but when you're plopping down megabucks to go on safari, I fail to see the point.

two different infectious disease specialists have recommended malarone to me. I came in with the book stuff on the others out there, incl doxy and larium, both said malarone wins, hands down.

more expenisve, but with fewer side-effects.

I'm leaving in a fortnight on my first African hunt, and have put my faith in Malerone, the county health travel nurse and advice from this forum.

My doctor agreed that Malarone wins hands down.

Get a script for Doxy as well though. It's definitely worth having as it will help with other ailments Malarone won't. Tick fever being the number one offender. If you start to feel sick even taking the Malarone take the Doxy too as recommended until it's gone! Trying to save on meds can result in a permanent boo-boo that's not worth risking.

I don't take any prevention, and just get by with 2-3 malaria bouts a year. Then I treat as needed.

Steer wide and far from Lariam. Old drug with bad side-effects.

Doxycycline is not really effective alone, and has some annoying side-effects, like most antibiotics.

Malarone, I've not taken yet, but has been recommended by my doctor here (Nigeria). I have a box in a drawer, just in case.

For treatment, my drug of choice is Coartem (Artemisin combined with Lumefantrin). No side-effects that I'm aware of, and very effective against the local strains.

Malerone for three safaris and no bugs yet...

Tolerated it well also...My safari drug of choice...


Mike

There was a report linked here recently that indicated that Larium was most effective followed closely be Malarone. Doxy was not competitive.

Larium has unpleasant side effects for some folks. I took it for two trips with no ill effects at all. I took a prescription for Doxy with me in case of tick fever but never had to use it.

I had to find a new Doc between the two trips because the old one retired. The new Doc was reticent to prescribe Larium until he found out it did not effect me ... Docs may be concerned about law suits on this one.

Phillip, unfortunately Coartem is not available in the US. Good drug though.

Malarone wins hands down for most of us.

Larium has the side effect profile that everyone worries about but truthfully the psychological side effects are not common in the majority of the population. If you are one of the lucky ones it can be very unpleasant. I have personally never had a problem with it and used it several times. I use Malarone now because of its side effect profile.

Doxycycline still works well except in areas with high resistance. It does cause some photo sensitivity. As stated before it is great for tick fever and not bad for travelers diarrhea but Cipro is still a better choice there.

I got extremely sick from taking Malarone. Doxy is ok but remember to use sunscreen. Larium didn't bother me too much except for the WEIRD dreams.

Take it before you leave so you know how your body will react.

I took doxy and malarone last year with no side effects. USE sunscreen to avoid sensitivity to UV like others have stated.

To be quite honest I believe (collectively we get a bit too paranoid) about Malaria ...

Personally I take Doxy and have done so over the last decade, but be aware ... NO medications are Fool Proof, some can in effect mask the symtoms to some degree, and that is dangerious as well.

Also Mozzies are quite or very good at becoming resistant to various medications, and there are different strains of Mozzies in different areaa, and a (lot of doctors) especially those whom are not TROPICAL DISEASE FUNDIS would not know for certain which areas contain which strains of Mozzie, so therin lies another problem

The most effective way is prevention and these are some key things to do

1) Wear long sleeved shirts and trousers in (early mornings) and towards dusk/evening as that is when the SOB's are the most prevalent.

2) Use an effective repellant & sleep under a net, naturally

3) Burn a coil in the chalet for a couple of hours at night prior to bedding down

4) Drink a lot of the old style Tonic Water, this of course used to contain quinine which was the main profolactic anti malarial medication in the OLD DAYS

Cheers, Peter

There has been a great deal of misinformation and half truths propagated in this thread. Additionally, anecdotal reports are misleading by there very nature. This is a topic I have eagerly studied and am very interested in. All of the meds in question work fine to prevent malaria WHEN TAKEN. Most case of prophylaxis failure are due to patients skipping doses or failure to take meds for a while when returning (terminal prophylaxis).

There are very few studies which compare different antimalarial to each other for prophylaxis. The few studies I have seen generally indicate that primaquin = doxy = mefloquin (Larium). Malarone is the new kid on the block. It has been shown in trials to be more effective in malaria treatment than some other regiments, but has never and I repeat NEVER has been shown to be more effective at preventing malaria. The few studies regarding prophylaxis indicate that Malarone = Larium but no better.

I have seen on this board to many times to count that you should go with Malarone and not try to slide by with cheaper drugs. Unlike most areas, with drugs you absolutely do not usually get what you pay for. Take aspirin for example. It is very cheap, yet is more likely to save your life immediately after a heart attack than just anything other than getting to a cath lab. HCTZ is a near ancient blood pressure medication that is dirt cheap and is recognized by the largest high blood pressure society treatment guidelines (JNC 7) as the first line hypertension medication for most patients. Malarone is new, patent protected by Glaxo-Smith Kline, and expensive. If doxycycline and aspirin were discovered today and patented, they might cost $8/pill. Once it is generic, Malarone will be less expensive and presumably less attractive to some physicians/patients.

Don't get me wrong, Malarone is a great medication and very effective, but so are a lot of other chemicals. There is no magic in it. There is the mystique of being new about it. It is a one trick pony as it only treats malaria. Malarone may eventually be shown to be a more effective prophylaxis, but don't count on it. GlaxoSmithKline has no interest is doing a large, expensive trial comparing it in this regard to doxy or Larium especially when the outcome would be in question. Admittedly, an inner voice in me thinks that it might be more protective against malaria than others due to it's superiority in treatment of malaria disease. So far the trials do not bear this out however.
Doxycycline is old and has some side-effects, but is very effective (92-99% effective in preventing malaria when taken appropriately including terminal prophylaxis after return), and is by far the most versatile malaria chemoprophylactic agent you can use as it protects against many other infections such as wound infections from normal skin flora including the difficult to treat MRSA infections.

In the end, pick Malarone, primaquin, doxy or Larium. They all will work fine. Find the one that give you a tolerable side effect profile and use it. Just take the damn pills and don't miss doses. Bed nets, permetherine, DEET and long sleeves/pants.

Wes

i got reactions to both lariam and malarone so for the last few trips i've been using doxy. taken in the evening it minimizes the sunburn effect

quote:

Originally posted by D99:
Doxy only keeps you from getting symptoms. You still need to take another antibiotic when you get home for 2 weeks to 8 weeks (depending on the product) to kill the Malaria in your liver.

I don't know where that bit of info came from. I've just bought 6 months worth and asked the pharmacist if this was the case..... She told me that there is no requirement/necessity to take any other treatment. I also checked on the info sheet that comes with the drug and there no mention of it there either. It does owever say that one should take the drug for 4 weeks after to kill off anything in the liver.

It could of course be that you guys have different drugs available to you but according to my information, no additional drugs are necessary. - Acidophilis was however recommended to avoid thrush as I mentioned before.

If you are an American and have not built up some amunity to the African continent, then take Lariam or Malarone, its not worth the risk. It depends on which study one reads, but Tanzanian doctors have told me the use of Doxy by Americans is probably not the best choice, and of course its very sun sinsitive. Also it is used as a partial treatment for Malaria.

Try Lariam and Malarone before you go and see if it has any side effects. I have seen the effects of Malaria first hand, not to be toyed with IMO.. Most PHs have it BTW and it ain't pretty. I have not suffered any side effects from the use of Lariam so that is what I have always used and so do our troops in Iraq I am told.

I am not an expert on the subject and I only repeat what I have made a point to try and find out by asking the people who I believe to be experts in their field. Based on that I recommend Lariam or Malarone to my clients. Those that can take neither of these are pretty much locked in to Doxy, but again I am told it will probably only make malaria less severe if you contact it.

Tonic ie quinine water is a myth. It dosn't and never did contain enough quinine to make a difference.

quote:

Originally posted by Jeff Wemmer:
Guys,

Who "knows" if Doxycycline (sp?)is an effective preventative against Malaria?

JW

Most Aussie doctors pretty much prescribe Doxycycline as an alternative to Larium if you don't want that. At least the Travellors Medical Clinics do.

You must take it and any other medication for malaria for the prescribed period when you come home as well until the incubation period is over.

The main negative about it is increased sensitivity to sunburn so you usually take it in the evenings. I don't burn easily so that isn't a big deal for me.

I've also used Larium but don't like the effect eg dreams. Plus some past alternatives that aren't prescribed anymore.

mike - it's been my experience that africans use a quantity of gin with their tonic to keep everything away

quote:

Originally posted by butchloc:
mike - it's been my experience that africans use a quantity of gin with their tonic to keep everything away

butchloc

You got it on one ....

That (Gin & Tonic Malaria remedy) of course is in the (OLD WIVES TALES) category .....

I believe it dates back a bit to the old days of the early British/Colonials loving a gin and tonic at sundowner time, or in fact a half dozen or more gin and tonics

Cheers, Peter

I have always used Larium as has my wife and we have suffered no consequences or malaria.

The amount of tonic required for therapeutic dosing is ridiculous. However, needing the appropriate amount of gin to go with it, priceless.

Just back from Africa and on the Doxycycline as is used by most Australians. It also helps against Tick bite fever.
ozhunter

Personally, my wife and I take larium. I had one wierd dream, she had none. It is a shame because I really looked forward to the next dream.

Primaquin has been a poor choice in areas of high resistance.

Just returned form 3 weeks in northern Namibia. We were right on the edges of the malaria zone, so decided to take no chances. Wife took Larium as she is on blood thinners, and cannot take Malarone. I took Malarone and neither one of us had any bad side effects. The Larium wires her up for the first night after taking, and she can't sleep. That is the only problem we saw.

Judicious use of bug spray and long sleeves kept bites to a minimum, but the mossies were still bad for about an hour or so around sundown. No reason to take chances, tho.