I'm off to Tanzania next October and will have to take some malaria prevention drug, my question is which one? I've read that some can cause physical and/or mental problems and am interested in y'alls experiences with the various drugs out there. I wonder if there is a technical site where I could look up my options. I have an old PDR( Physicians Desk Reference), circa 1990, but would like a bit more up to date resource.

Lewis,

WE have been taking MEPHAQUIN for so many years, and have found it to be very effective. None of us have ever contacted malaria so far.

I am not sure, but I think it contains Larium. I personally have not noticed any ill effect from taking it on all my African hunts.

The regime is that one tablet is taken 7 days before arriving in Africa, and then one tablet is taken on the same day of the week, every week, as long as you are there. Then you continue to take it for three weeks after leaving Africa.

We're currently recommending Malarone as the anti malarial of choice. It's expensive but has the least side effects.

You might like to visit do an internet search for the site of the Medical Advisory Service for Travellers Abroad (MASTA) which is part of the London School of Hygene & Tropical Medicine where I'm sure you'll find all the up to the minute info.

I have yaken Larium for nine years with no ill effects at all. Should I be fortunate enough to go again I will continue to use it. Have had malaria once and that was enough. Used something else a couple of times in Belize and had no ill effects from it either. The two malarias require different medications in the different areas. Africa is much worse than Central America I understand.

No matter what you end up taking, I would suggest you try the drug out for a week or two, some time before going on your trip.

I have used Larium, Malarone and Doxycyclin.

However, I get random dizzy spells from the Larium, which is not a good thing when shooting, driving or in general! So I don't use it anymore. My wife on the otherhand has no side affects with it, and has used it on several occasions including a 9 month long duration.

I used Doxy for 9 months in a row with no side affects as long as I took it in the evening. If I took the pill at breakfast, I would become sunburned quite easily. Even after my skin was used to being in the African sun for months.

I first tried Malarone as a cure when I had Malaria, and at the time didn't notice any side affects. But, since I had Malaria, it's hard to say which discomforts were due to the disease and which were potentially due to the pills...

So I went with Malarone the last time I was in Africa. It is supposed to be the pill with least side affects. But that does not mean it is without side affects!!! I experianced very bad dreams while taking the pills. Vivid, wierd nightmares like I cannot remember ever having had before in my life. Every night. It just so happend that one of our trackers came down with Malaria (or at least the symptoms), and as he and the PH had no cure for Malaria with them, I gave him the rest of my Malarone as a cure (in the correct dosage of course). I found it interesting that the bad dreams went away already on the first night without Malarone! So I have no doubt what caused them. And when I reported this to a specialist in tropical medicine I know, he told me that he had heard the same thing from several others that used Malarone.

So to repeat myself, give the differant ones a try before leaving, to spare yourself any problems while your hunting, and more interested in having a good time!

MD Travel Health - Malaria, note the numerous links at the bottom of the page (to the CDC, WHO, etc.)

Regards,

Terry

Lewis50

The real "vets" on this thread give you good advice. You mention having a copy of the PDR. If this is your very first time in taking malaria prophylactics I would urge you to seek out a doctor with experience in tropical medicine (there are lots of them in your state) to give a prescription. You may hear that you can buy malaria prophylactics "over the counter" in Africa ( and it was certainly true in my time back in 1993) but don't do it. All the malaria drugs require that you build up what the doctors call an "envelope" meaning that you must take the medicine for at least two weeks before you enter a malaria area. Everybody has a different reaction to such and such a drug. I used Larium on my one and only trip for nearly a month in Africa. I never had a single kind of side effect reaction to it. Does that prove that Larium is best? Of course not! My point is that a doctor experienced in tropical medicine is your best bet. ( Not the local GP who will sneak a look at the PDR before writing a prescription) Just my thoughts.

Larium has done its job for me but the last couple of trips it would seem I had bouts of unfounded anxiety. This year I'm trying Malorone that worked very well for Sadie on our last trip. She did say she missed the vivid dreams.

Mark

Mefloquin is Larium BTW. The type of malaria which is endemic in southern africa is P. falciparum. This is the most dangerous of the several species(falciparum, malariae, ovale,and vivax). It can cause permanent damage to liver, lungs, kidneys, and brain. This is not a disease to be taken lightly as there is a significant associated mortality. Larium is a very good drug and I have used it many times. However, some people experience rather unpalatable side effects such as dysphorias, nightmares(I've had these), gastro-intestinal complaints, and even psychotic events. Most however don't have any severe side effects. The reason there has been a transition over to Malarone is twofold: 1)There seems to be fewer side effects reported in patients taking Malarone 2) There have been fewer reported strains of Plasmodium falciparum which are resistant to Malarone as compared to Larium. One caveat is that Larium shows much greater activity against the other strains than Malarone, at least in one study. FWIW I took Malarone on my last two forays to the continent.

Geronimo

Say, Lewis50, did I meet you on the plane to Cincinnati?

Did you check what you took last time? If you have taken Larium before with no ill effects then you are probably safe to use it again. I'm no doctor, but I suspect it is an individual brain chemistry effect.

I know I'll never take it again!

Lewis,

I have taken malerone in RSA and Zim. and I will continue to use it in Tanzania...

Mike

Going to Kenya in Feb. and will be using Malarone. I'll let you know how it goes.

The Australian Vaccanation Center recommend Doxycycline or Chlorquin.
On all of my trips through Africa I have used Doxycycline wich is an Antibiotic and can also protect you from Tick Bite Fever.
As EricD has pointed out the side effects are that ones skin and eyes are more effected by the sun. I also recommend taking them in the late afternoon.
I also carry a twelve pack of Malarone as a first step if symptoms occur.
An additional step one can take is Homoeopathic remedies for provention and cure.

I also used ultrathom by 3m for a repellant and I also sprayed my clothes with an insecticide Permethrin or something like it..Killls insects that land on clothes..Also sprayed insside of PHs vehicle and underseats for noseeums..Lasts for a number of washings....
I also found a natural repellant which is or may repell tsetse flies Squeeter Beater I am going to take it to the Selous in July Aug..

Mike

ozhunter, Doxycycline and Chloroquin are certainly options for those who are unable or unwilling to take the two above mentioned medications. However, these two drugs have not shown nearly the effectiveness against P. falciparum as Larium or Malarone. Personally, with the other two easily gotten in Oz or the US, I wouldn't take the chance. Just my 2 cents and I won't even send a bill

Geronimo

For me Doxy was the one with the fewest side effects. Larium would be second(man those dreams are weird) with few side effects other then the dreams. I got very sick taking Malarone. Won't do that again. It really is different what works for each person. I would take the advice of someone else on this thread and give it a try for a couple weeks at some point before your trip with enough time to switch if need be.

Thanks for the help gang. Don-G, it weren't me I ain't been to Cincinati in a coon's age.
I'll take the advice, do the research, and try my chosen poison in the next few months. If my hair falls out, I develope warts, or start dreaming of sexual congress with my cattle I'll switch to another brand of fix-it juice.

Malarone

Always used Malarone, never any side effects, Costco seemed to have the best price.

I start my 7 day trial run with Malarone tomorrow - I'll let you know. Larium really messed with my head - alot! It started two days after I first took it and continued for about six weeks after I stopped. Fingers crossed on the Malarone.

Too many PH's have told me NOT to take LARIUM .
I also found in a African travel health book{2002} that the British health organization also does not recomend larium.

I had bad nightmares and felt flu-like symptoms when I took Larium. After talking to my doctor I quit the regimen early - I just couldn't take the nightmares.

They were really intense - and I remembered them all too clearly.

I've heard stories of Peace Corps volunteers quitting their larium just so they could feel ok - they were willing to risk malaria to not have the side effects.

I'll be looking for an alternative (maybe Malarone!) next time I go to Africa.

ozhunter, please don't take this the wrong way, but using a 4year old medical document as a reference is like reading a 1960's auto repair manual to fix your car. I don't feel it is responsible to advise against taking an effective medication unless there is a specific contraindication to taking it. I see that there are some of our fellow AR members who have had problems with Lariam and they perhaps should seek alternative remedies. But, many thousands of people have taken it without any side effects and it remains a very effective drug against several species of malaria organisms. Still, in light of recent trials, Malarone seems to get the nod, particularly when P. falciparum is of concern.

Geronimo

I used Larium on several trips, and experienced vivid dreams, and several days of extreme panic attacks. For my last Safari, my doctor switched me to Malarone, and I had no ill effects from it. I'll use it again.

Another precaution I follow is each evening before I leave my tent or sleeping quarters to go have dinner, I spray the tent/room with Raid or its local equivalent.

Lewis50

Forgot to mention the best reason of all for seeing a doctor first. Most malaria prophylactics can affect heart action and if you have any history of heart problems you must see a doctor about what you can take. These pills are not the equivalent of swallowing a couple of low dose aspirins and as you see from the posts people can have widely varying experiences with malaria prophylactics. I really want to urge you to see a doctor experienced in tropical medicine. Atlanta is full of first class hospitals and first class doctors. See one. You will need a battery of shots and pills anyway for hepatitis, typhus,etc. (Don't forget to get the WHO form filled out by the doctor to show what you have received) (I'll bet his/her fee will be no higher than you would pay some GP)

Once again thanks for the tips. I'll be getting my annual physical next month and will see what my doctor thinks. I have faith in his judgement and honesty. He just returned from a few months in the middle east sandbox where he was treating troups in Basra. If he doesn't know something he tells you his best guess and refers you to someone with more knowledge, a trait I value.

I hate Larium and will never take it again. Makes me depressed. Heck, I'm depressed thinking that I used to be depressed while taking it.

Lewis50:

Your doctor sounds like a very good one so I'll stop bugging you! ( I always trusted a doctor who says that he doesn't know everything. It's the ones who try to give the impression they do that scare me)

quote:

Originally posted by Geronomo:
ozhunter, Doxycycline and Chloroquin are certainly options for those who are unable or unwilling to take the two above mentioned medications. However, these two drugs have not shown nearly the effectiveness against P. falciparum as Larium or Malarone. Personally, with the other two easily gotten in Oz or the US, I wouldn't take the chance. Just my 2 cents and I won't even send a bill

Geronimo

Geronimo,
I am curious what data there is to support the assertion the doxycycline is not as effective as Malarone or mefloquine. To the contrary, I have seen abstracts that suggest equal efficacy of doxy. As for drug resistance, outside of western Africa, African P. Falciparum is unlikely to be resistant to chloroquine let alone mefloquine. Mefloquine resistance is very rare in Africa.

Lewis50,
All of the regiments have proven to be very effective IF taken regularly. The most common reason that people get malaria on prophylaxis is the same as why a lot of women on birth control get pregnant: not taking the meds every day. The point is, the best prophylaxis is the one you will take every day. This is where the side effect profile enters into the equation. Another advantage of doxy is that it is active against a great number of non-malarial infections including most atypical bacteria, many skin infections, and most tick born illnesses.

If your Dr. is a military doc, he is likely to suggest mefloquine as that has been what we have been giving thousands of our troops with very small numbers of serious side effects.

By far the most effective malaria prophylaxis is to limit the number of mosquito bites. That means: wear long sleeves and pants treated with Permethrin, use permethrin impregnated nets, and use DEET on neck/face/hands regularly.

Wes

WESR, I did not say that there was significant resistance identified against Mephloquin. However, there have been studies, including one done out of South Africa which was posted about one year ago on this site, which identified fewer(as in 2% vs. 5%) strains which were resistant to Malarone as compared to Larium. That same study included Doxycycline and Quinine derivatives like Chloroquine. I'll do a search and try to pull it up.

Geronimo

I'm using Doxycline right now. I would recommend people try to get decent advice from a doctor on this sort of thing and much preferably from someone who knows something about tropical diseases. I use a travellors medical clinic for travel advice as they keep up to date on the latest developments.

The Travellors Medical Clinic in Adelaide, Australia advises Larium, but if you may be affected by it, then Doxycycline. Larium of course is a once a week pill while Doxy is each day.

The key thing is to take it as prescribed especially for the period AFTER returning as the BEFORE period is not very important. If bitten by a malarial carrying mosquito the risk continues for about two weeks after you return.

The main thing is not get get bitten by mosquitos if possible. I watched a 'lovely' documentary just after returning a week or so ago and it detailed a large number of very 'choice' ailments that can be had from mosquitoes.

The best were:
Small worms which infect your entire body and are usually discovered when they slither under the skin of your eyeball. The eggs are transferred from mosquito bites. The fellow shown had them for three years.
A form of incurable elephantisis, which is considerable swelling of parts of your body, in the doco a leg and testicles to several times normal size. Mosquito bite.
Among others.

"Fascinating" stuff.

I will be taking more RID or mosquito repellant on my next trip.

Edited to add: I am already crazy enough not to add to it by taking larium.

Just wanted to post a corrected follow-up. I went on the CDC site and the WHO site as well as contacted one of my ID (infectious disease) colleagues. I stand in error on the Doxycycline statement. It is effective in areas with Chloroquine and Mefloquine resistant strains of P. falciparum and P. vivax. However, although the highest number of resistant strains of P. falciparum were identified in the Asia Pacific region, since 2002 these resistance patterns are being reported with greater frequency in southern Africa. Malarone and Doxycycline are specifically named as first line prophylactic drugs in Chloroquine resistant areas(most of sub-Saharan Africa)with Primaquine use available in special circumstances. Fansidar(which was at one time commonly used as a back up to Larium) is no longer recommended.

Geronimo

Geronimo

If you try larium/mefloquine, try it months before you leave. It was 3 months before I got a decent night's sleep and 5 years later I still dream in Technicolor. That was from one pill.

You could not pay me enough to take another one.

i'll agree with don g - larium sent me to la la land, and malarone wasn't much better. Been taking doxy and cloroquin for the last few trips.

I'm on Doxy right now, in the post-trip stage.

Has anyone ever had vivid dreams with Doxy as well? I certainly seem to.

Maybe I'm just naturally nuts.

One week ago I finished my ten day trial run for malarone. All I can say is USE IT!! I suffered zero side effects. I even took it on full stomach, empty stomach, etc. and could not get it to give me anything negative. No mood swings, dreams, or anything. I don't care what it costs - it is worth 10 times what larium is, at least. JMO

My wife and I used Larium on both of our trips. She had zero side effects. I had one funny dream and really enjoyed it. I like the idea of taking one pill a week. It is much easier.

There is a South African Doc/Researcher who is supposed to be the WORD on Malaria. I forgot his name. On my last trip I was with a PH who told me about this gentleman's bio. Seems he is the one who said that if in an area with falciparum, then Doxy is out. My PH said that this Doc had mapped the strains although it would make sense that such a map would be continuosly evolving. If there was a way to identify this man AND get his research and maps posted here it would be of great benefit- Any ideas?

Lewis50,

I don't know what part of Georgia you are from, but if you are anywhere near Gainesville, I highly recommend the International Travel Clinic at the Hall County Health Department. The ladies there are great and can answer your questions. You will fill out a questionaire that will indicate whether or not you are susceptible to side effects from Larium.

If you are not located in N GA, try to find a travel clinic rather than using your regular doctor.

George

quote:

Originally posted by Geronomo:
There have been fewer reported strains of Plasmodium falciparum which are resistant to Malarone as compared to Larium. One caveat is that Larium shows much greater activity against the other strains than Malarone, at least in one study. Geronimo

Can you expand on this. Maybe I am reading it wrong but it looks as if you are saying Malarone isn't as good as Larium.

FWIW:
1. Larium makes me crazy. Anxious, irritable, suspect of everybody. I do not do well on it.
2. Doxy - teh sun is very hard on me if I take Doxy.
3. Malarone. No side effects at all.

People need to know that it is possible for Larium to ruin your hunt. I have seen it happen, I have had it severly effect my enjoyment of the hunt. It impares my ability to make rational decisions at times, most notablby on the day I take it.

Take Malarone.