Malaria questions

I’m going to Guatemala in September. I am from the UK, so have had all the standard vaccinations throughout school. Recently I had a Hep A & Typhoid combined vaccination, and will be taking Chloroquine anti-malaria tablets under the advice from my local GP.

I’m planning on working in Columbia after this. Problem is there is considerable chloroquine resistance in this area and the choice is between Malarone, Lariam or Doxycycline.

Is it safe to take two kinds of anti-malaria drugs at the same time and which would you recommend? Also, as I’m flying back out of Mexico City do I still need to carry on with my Chloroquine medication when I’m in Columbia? Thanks!!!!!!!!!!!!!!!!!!

Hi Tommy,

For your own safety and health, you really should ask your doctor/GP that question.

Where in Guatemala and Colombia will you be? Unless you are going to be in the jungle (i.e. El Peten or Rio Dulce in Guatemala), there is no need to take the drugs. Also check to see if Yellow Fever vaccine is required in Colombia - as it may be if you plan to go to the Amazon basin.

Each of the drugs you listed have different dosages. For example, Malarone you start 1 week before heading into the jungle (if I recall correctly...). Lariam, I have heard can make people hallucinate or depressed. And Doxycycline is a good anti-biotic -- but taking antibiotics may hinder your immune system in the long term if you take them without really needing to.

Again...I'm not a medical professional - so it's better if you speak to your doctor -- of even better, a doctor that specializes in infectious diseases or travel.

Cheers,
Kay

Kay and Franks Trip to Central America

Seeing a doctor at a travel clinic instead of a GP would already have answered this for you. You are unlikely to find any MDs on this board, but my gut feeling is that unless you want to experiment on yourself with drug interactions, you should skip chloroquine and limit yourself to just one thing that will work in both malarial locales. If you want to use two, Check travmed.com. Any drug you take needs to be contiued for 4 weeka fter leavint the particular area.

Hi Tommy,

This is really a question for your doctor. However, my understanding (and unqualified opinion) is you can use any one of the post chloroquine anti-malaria drugs in an areas where chloroquine still works. The risk is you are introducing a drug in an area where it is not needed yet so this may shorten it's usefulness (due to resistance) if chloroquine looses it's effectiveness. If I had to make this decision without a doctor I would choose to use the least recent anti-malaria drug (or least dangerous) that works in all areas. Personally I would not take both.

BY FAR the best idea is to pose this exact question to your doctor or travel clinic.

Also, not all areas of Guatemala are malaria risk. Some area are too high and some haven't had a case in many years. Of course there is always some risk in these areas....even if you are taking the appropriate drug.

Have fun!

I'll be travelling in CA and then staright into a Malaria zone in SA. My GP (I highly recommend to visit a GP to you too!!) said that Cloroquine won't be ok in SA and you should not take 2 anti-malarials at the same time. You will have to take Cloroquine 4 weeks after leaving the Malaria area and most anti-malarials need to be taken at least a weeks before exposure.

As #1 pointed out, Lariam has severe side effects but only needs to be taken once a week.
Malarone is quite expensive and as far as I know should not be taken for more than 4 weeks.

My GP advised Doxycyclin as it is effective in CA and SA and it is affordable. But as everyone else pointed out, you should seek the advice of your GP.

Personally, I don't like Deet. It is bad for the environment and bad for your health. The high-deet stuff melted my flip-flops too! The OFF!Skintastic for Families is pretty good - only about 5% DEET and smells fine.

There are several new healthier options that are non-Deet. Most have proven to be ineffective. Except one: REPEL with Lemon Eucaplyptis Oil. We tried it in Nicaragua and it works great. Now that is our first choice when available.

This month's edition of Backpacker Magazine (US) - has a great review of most of the mosquito repellents - everything from Ben's Wilderness, to 98% Deet, to REPEL. Repel ranked really high. More effective than most of the deet stuff. And it smells really good. And you'll have a happier conscience about being good to the environment!

Cheers,
Kay

Kay and Franks Trip to Central America 2007

Thank you all!!!I will book in with my local travel clinic and post their advice back on here, as I hope it may be useful for other people. Thanks!!!!:)

#6...evidence of environmental damage from DEET??? Hell, it melted your flip flops. Without the DEET those suckers would have laid around for years. You seem more concerned about smelling good. You go humping a pack through the jungle and you are going to stink...just ask those around you.

All the doctors that i talked to advised me that some of the side affects of taking anti-malaria are to bad to risk, and that going to CA it might just be better to take your chances....

No self-respecting doctor is going to say that chloroquine's side effects are too bad to risk. Because it simply is not true! There are practically no side effects to chloroquine. Read up on it at the CDC website.

Well, here I go again. Striving for accuracy in the dispensing of information. Regarding comments in #6.

States that deet is bad for your health. The CDC and the FDC say it is safe for your health. Sure, you could overdose on it, just like you could overdose on vitamin C or any number of other things, but overdosing is not what we're talking about here. Deet's been around since WWII, so there's been plenty of time to study it.

According to the studies done by Consumer Reports, and others, a product relying solely on 5% deet won't repel mozzies long enough to be much good for most situations. The effective time varies with the aggressiveness of the different mosquito species, and the effective repelling time for agressivive mozzies for 5% deet is zero; as it is for many products on the market, many of which claim to work.

Repel is a brand, not an ingrediant. They make a number of different repellents, most of which didn't work in the CU studies for a long enough time to be effective for most situations. Again, the lenght of effective time varies with the different species of mozzies. So to say that Repel is more effective than most of the deet stuff is flat out inaccurate and misleading.

According to the CU studies, nothing is more effective than the 30% deet products. And only one non-deet product was even in the same ballpark with the 30% deet (the above mentioned Repel Lemon Eucalyptus Oil (I think there are two more words to the complete name for this product).

A bunch of brands will probably start adding a bit of lemon eucalyptus oil to their non-deet products and promote them as being tested effective. Truth is, according to CU, lemon eucalyptus oil is probably just like deet as far as the relationship between strength of ingrediant and effectiveness.

I, too, would like to see a reference to the studies which say the use of deet as a repellent is bad for the environment.

Aloysius please check into things before posting rash statements. Search side effects of any of the anti-malaria medications listed above and you will find some very serious side effects. My advice to you vanquish is to ask your doctor and maybe get a second opinion, but I would not rely on information coming from a forum. Obviously people on the internet open their mouths with out any knowledge at all of what they are talking of. Just because you didn't happen to get any of the side effects Aloysius, since I'm guessing thats what your basing your information off of, doesn't mean that their aren' t any.

zach, my info comes from the CDC website, as well as from medical professionals including those working in travel clinics, not from my personal experience. In other words, straight from the horses mouth. So from reading up on it I am very much aware of the side effects. I should have worded my third sentence better, but anyone heeding my fourth sentence advice to read about it on the CDC website will there find the best wording of all about side effects. Choloquine is in a whole different league than the other drugs. I stand by my guns that no doctor is going to say that the side effects of choloquine are too bad to risk. They might make that statement to certain individuals with known specific conditions that make it risky, but not as a blanket statement. I spent many hours on the CDC website learning all sorts of good information about travel medical concerns; snake bite, malaria, dengue fever, you name it. I consider it important to be informed. Again, I wish I had worded the third sentence better. If I could edit I would do so.

Buen viaje!

Doctors and Travel Clinics also tend to cover their ass. Being one who reacts to many things,
I've chosen to not take anti malarias on my trips even though the doctors said to. If malaria
exits in the country, they recommend taking the meds. I travel with a mosquito tent that is also good
for other bugs and critters (bedbugs, rats, mice etc as you never know where you might find yourself).
The malarial mozzie is out at night.

When I get to an area I ask the pharmacist and or doctor
to find out if there are current outbreaks of malaria. It was recommended that I take the stuff in India,
there were no current outbreaks in the areas I traveled and very few mozzies. This did not warrant
subjecting my body to those strong meds. Westerners that live in malaria areas do not live on those
meds. I try to weigh the risk and if there ends up being mozzies, I am extra careful. So far, there have
been few times to even be concerned. If I were to develope any symptoms, I would seek out a blood test
and then take medication to treat if needed.

Since you have decided to take meds, seek out medical advice on the best way to take it and for how long.

The CDC website tells you the proper way and for how long to take cholorquine. It also gives you all sorts of useful information about avoiding mosquito bites. Malaria is not the only concern. In fact it is probably not even the biggest concern in Central America. That honor probably falls to dengue fever, and those are daytime mozzies.

Buen viaje!

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<hr>Aloysius please check into things before posting rash statements. Search side effects of any of the anti-malaria medications listed above and you will find some very serious side effects. My advice to you vanquish is to ask your doctor and maybe get a second opinion, but I would not rely on information coming from a forum. Obviously people on the internet open their mouths with out any knowledge at all of what they are talking of. Just because you didn't happen to get any of the side effects Aloysius, since I'm guessing thats what your basing your information off of, doesn't mean that their aren' t any.<hr></blockquote>

And just because you didn't get malaria when you travelled in a malarial area doesn't mean that others won't either.

All drugs have potential side effects. Just like all diseases can potentially be caught. It is all a matter of weighing up the relative risks of each.

In making a decision about whether to take malarials, you have to compare:
(1) the risks associated with malaria (e.g. death) and the risk that you will contract malaria in an area where you will be; and
(2) the potential side effects of anti-malarials and the risk that you will suffer one of those side effects.

Indeed, everything we do is ultimately down to a risk equation. The potential side effects of a head-on car crash are pretty serious too (much more serious than anti-malarial side effects, actually). But does that stop people driving just because the risk exists? People make an assessment and usually decide they're prepared to take that risk. It's the same with anti-malarials - the mere possibility of side effects doesn't answer the question - it just gives you one piece of information, which you then need to weigh up with all the other risks (including the risk of contracting malaria) before making a (hopefully informed and reasoned) choice.

The generally accepted medical view is that in an area where malaria is endemic (which includes the Peten and other lowland areas of Guatemala, but not the highlands), then the overall risks of malaria far outweigh the potential risks of side effects of the anti-malarials. I have yet to come across a reasoned body of medical opinion to the contrary. If you know of it, please send a link.

Zach... I've been taking anti malarials since the '70s. My info comes from the CDC, WHO and military doctors well trained in jungle survival and tropical diseases. Of the anti malarials used in Latin America, only one has a long history of medical warnings andthat is Larium... not needed in Central America. Even it's side effects of psychotic delusions are now thought to occur mainly in those with pre existing if undiagnosed mental disorders. I've come across one case of some psycho chick who took a bottle of at least 30 chloroquine in an apparent suicide attempt. Fortunately they worked and killed her. Fact is that malaria, even the relatively mild kind found in CA can cause permanent damage. I think your doctors are idiots...where did you find them? But... I also think it is great that you aren't taking the pills. Keep it up. In fact, it would be best if you weaned yourself off all modern western medicines. Do your part to combat global warming.

Obviously it's up to yourself if you take them or not. My dad contracted Malaria and he's still suffering from the effects and that's for more than 40 years now. I'd rather have some mild side-effect (not the Lariam kind, mind you) and don't suffer from Malaria.
I haven't come accross a doctor who would advise against anti malarials but there are some gangsters about ;)
Anyhow, OP has made an appointment in the Travel Clinic and I'm sure we'll get a report on what they have advised too.

Everyone is an expert, huh?

How many of you soapboxers (yes, you Aloysius, among others. Mr "Here I go Again" - get over yourself) have a medical degree and experience as a medical professional in a tropical malaria-prone region?

Hmmm.....

Read the CDC site, again, Aloysius. They do refer to the Lemon Euccalyptus Oil as showing effective in preliminary studies (latest report was 2002 - outdated). More recently, the New England Journal of medicine and a report in the Wall Street Journal states that tests show Lemon Eucalyptus Oil is effective for at least 120 minutes. Very high ranking.

And the CDC site states that DEET should not be used on children and that cases of seizures and fatal reactions have occured when DEET has been used on exposed wounds/cuts. And Canada as a country is phasing out products with more than 50% DEET.

Not to even mention the enviromental damage caused by the production, use, and disposal of DEET products, especially to marine life.

What would I rather take? Hmmmm....

#19, no need to promote the worth of Repel's Lemon Eucalyptus spray to me. You're preaching to the choir. I'm have been recommeding it as an effective alternative to deet since the CDC and Consumer Reports both did so in 2005. I have also been recommending that people read the CDC website and the Consumer Reports articles (I do so in #5, 10, 11, 13, 15 just on this one thread alone). The tests referred to in the Wall Street Journal article you note were those conducted by Consumer Reports. I posted a fair amount of detail about those tests here on ThornTree about 3 weeks ago. You should be able to find it with a search.

In the Consumer Reports tests the Repel Lemon Eucalyptus spray was effective against an aggressive species of mozzies for 4-7 hours, and against a tamer species for 12 hours. That's some very good results. But a couple of things need to be noted. It doesn't solve the need for all night protection against agressive mozzies while sleeping out in the bush. A 98% deet does. And other lemon eucalyptus products with lower concentrations of lemon eucalyptus may not repel for very long, so beware of the expected misleading claims on some new lemon eucalyptus products. Because of the rapid increase in mosquito-spread diseases around the world, and the development of new repellent products, I expect to see Consumer Reports do another test incorporating the new products within a year or two. I'll pass it on when they do.

Buen viaje!

Aloysius, I am sorry for sounding rude and maybe a bit harsh. I did not mean to slander you in any way, it's just that your sentence stating that there are no side effects is wrong, and, as you stated could have been differently worded. As to the other people posting I did not tell him to not take them because that is what my doctors said, I was just merely telling him what my doctors said. And to who ever it was posting that my doctor is an idiot... get bent. I'm not going to turn this into a whose doctor is better arguement, but my doctor is extremely qualified and he him self has been to CA with Doctors Without Borders several times including Guatemala, and he explained to me that in his own mind the risk of getting malaria in most of these areas is low enough, especially since I'm an extremely healthy teenager, that it wasn't necesary to take the anti-malaria. In no way did he tell me not to take it, he said that if I wanted it he would prescribe it for me, but that if it was him, he would not see the point in taking it, especially since there is the possibilties of side effects. It would be like taking Advil in the morning just because you MIGHT get a headache at some time in the day, only you also ran the risks of naseau and dirrarea (sorry for spelling) from the advil... its just not necesary to take it.

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<hr>All the doctors that i talked to advised me that some of the side affects of taking anti-malaria are to bad to risk,<hr></blockquote>

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<hr>especially since there is the possibilties of side effects<hr></blockquote>

zach...two different sentences there on your part.

So we've been arguing with a kiddie. Please go back to your nintendo.

Come on..... you will never get anyone to agree on this topic including doctors. A doctor
friend of mine has made over 15 trips to India, having never taken meds. He spends 2-3
months a year there and does not want to take that much medication.

I talked to some researchers who work in the jungle, they say that they save the meds for IF they
get malaria. Prompt attention to malaria type symptoms is vital, a blood test and then
treatment. Give it up, there are different opinions and situations out there.

Probably more of a risk in 3rd world countries is accidents, better carry a helmet with you.

So Zach is a youngster, be nice.

Goodtimebob I'm not quite sure what your saying at all. Yes I am only 18, but atleast I can get my point across. Intelligence doesn't always come with age my friend. But back to your post, I'm not sure if your trying to degrade me because my grammar wasn't proper or if you think that my two sentences contradict each other in some way. So lets start with the grammar... GET OVER IT. Now on to possibility number two. Those two sentences were posted in two different replys and in different context. Sentence number one came from my first post stating that I was told that the chance of getting the side effects was greater than the chance of getting malaria. Sentence two was my response to peoples comments that there was no chance that you could get side effects, that side effects for anti-malaria didn't even exist. So I'm not quite sure what to say other than you really need to 1. Read things more carefully before you degrade someone and 2. Learn to be able to get your point accross, all adults should have this skill. Oh, and I don't play videogames, I travel.

Thanks Chapatigirl for sticking up for me.

And on a final note, Chapatigirl is right, no one will ever agree on this. So my last advice is to seek all the PROFESSSIONAL opinions you can, and then make up your own mind on to rather you should take the medicine, or which medicines to takes.

Bob - lay off. no need to name call. After all - one could strike back at you and call you an old fart whose selfish consuming habits are destroying the environment for the younger generation. The fight could go on and on.

If anything, the younger generation has a fresher and less stubborn view.

Hi zack (I like the name, one of my favorites). In #24 you admonish Bob to read things more carefully. You also state that a comment you made was in response to "peoples comments that there was no chance that you could get side effects, that side effects for anti-malaria didn't even exist." No one said that.

Buen viaje!

NYC... Someone is older automatically puts them in the selfish consuming class?? Aren't you intelligent?

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<hr>the younger generation has a fresher and less stubborn view.<hr></blockquote>

Little boy Zach has the view of someone who wouldn't know how to do research if he was slapped up the head. But since he won't ever go to Central America that won't happen. You will note that I never said he should take malaria pills. In fact he is the perfect example of someone who should avoid all western medicine. From your statements on here it would seem you too fit in that category. Use holistic and shamanistic methods only. Protecting the environment begins at home. If you have bred... follow that philosphy there. Let's clear up this tragic error in the gene pool. Still waiting for that link to massive environmental degradation by DEET.

Oh, Bob! Zach is going to Guatemala and is probably going to have a grand time of it, maybe even to some small extent with our help here. You and I can only imagine being "only 18" and being both curious enough and able enough to head off to a third world country as wonderful as Guatemala. Do I detect some envy here, my friend? I do feel envious, but in a bit of a nicer way.

Zach, please read all the safety posts about Guatemala before you go and do come back and tell us how it went.

I'll make sure to do that Mayaphile, thanks!

Well go read this months National Geo as it is all about malaria. Will answer all your questions. Also I am not a big fan of deet either as it ate my swatch watch so I wonder what it will do to me long term so I am now using Cutter advantage. Of course I always take the meds for prevention of this horrible illness and that is now 17 years with thrips three times a years. Am still alive and only side effect was it killed my desire to eat alot. I would not chance a trip without the meds as malaria is forever. Just have Travel Insurance on the chanched you become ill and have to be airlifted out as the airlines wont let you fly if ill.