[HowieUK]

I will be travelling all over India, North and South for at least a year!

I am a bit worried about taking malaria tablets for that amount of time. Do other long term travellers take tablets for long periods or do they take the risk and forget about them?

Howie

[Seventies'Neil]

A year is too long to be popping Malaria Meds Howie,
C'mon you've been there & done it all before & survived,,,,,,,,,,,,,,,,,,

[HowieUK]

Yes I know, but I didn't take anything before!

I'm a bit more concerned about health issues today than I was 20 and 30 years ago.
What do people think about taking tablets for a month or two and then stopping taking them?

Would this be better than not taking them at all?

Howie

[malkers]

By all accounts Howie you're supposed to take them at least a month before and a month after so it prob wouldn't do much good just taking them for a month.

I been here 2 years and never took one, thats not being clever or arsey but I just can't be bothered with the routine for the low risk involved.

I don't know many others here who bother with them either unless they are short term visitors and how many Indians take them after all.

In saying that, I've been rough for the last 4 weeks so heaven knows what I might have

Take plenty of sprays with you and cover up well at night is my advice, I've also not been to the regions you will be visiting so no idea of the level of risk there.

I'm no help at all me!!

Malc

[iwanttogoback]

howie

firstly congratulations - at last, a malaria thread.

my view (and this is not someone who has spent that long in India) is that malaria, if you catch it, is still a serious disease: over a million people a year still die from it.

if I was going to spend a year then I would be looking at:

1: malaria risk in the places I was visiting - it changes according to season and location;

2: meds available and side effects. and, if you do take them, do you need to take them before and after.

for myself, I used doxycycline (an antibiotic) because my research suggested that the possible side effects of this were more acceptable than some of the other medication. I think I had to take it for a week before and a week after, not the month that malkers recommends.

and maybe you should consider whether you are the kind of person that mozzies actually bite? i'm not and didn't get a single bite in India despite the size of the little blighters, particularly in Mumbai.

[70s-80s overlander]

Two comments:

(1) your choice of Doxycycline for the LONG TERM traveler is probably right on. Of the various articles I have seen, the following is the best:
http://www.hpa.org.u...(3)p200-208.pdf
The main web page also has intelligent discussions: http://www.hpa.org.u...malaria_faq.htm
The normal dose of Doxycycline is 100mg per day, but if you think you have contracted malaria (or typhus or cholera or dysentery or anthrax), then you should take it twice a day until you can find a hospital.

(2) about 6+ months ago I usefully exchanged e-mails with a south Indian malaria expert in Mangalore:
http://www.malariasi...InMangalore.htm
If you are going to be on the road for a year, I would recommend stopping in to see one of these malaria experts quarterly. I am sure that this Dr. B.S. Kakkilaya in Mangalore can refer you to colleagues in other sections of the country. On this last note, please tell us what you learn.

[ploma]

I'm not a doctor, just a Biologist, and when I have to decide about taking malaria pills for my first six month trip to India I was asking to some doctors here in Barcelona and even while in India talked with some more. I haven't got a clear answer from them, and eachone told me a slightly different thing… all of them agree that 6 month with antimalarials would be hard for any liver (but not necessary bad).

At the end the decision will be yours and I think Iwanttogoback has clearly stated the main issues.

I've chosen not to take antimalaria pills when travelling for more than 2 month, trying to leave my liver healthy, and when travelling around India or SEA for less than two month i've taken diferent antimalarials without any side effects.

But, again, that's a real personal option and I don't know which areas are you going to visit… Maybe yo can just take it when you know you're crossing a high risk area (and the days before and after, in order to make the treatment usefull)? I mean if you know that just in February you'll be around an area with high incidence of malaria then take it for that part of the trip.

uribaba

[iwanttogoback]

Quote

Maybe yo can just take it when you know you're crossing a high risk area (and the days before and after, in order to make the treatment usefull)? I mean if you know that just in February you'll be around an area with high incidence of malaria then take it for that part of the trip.

I think that is probably what I would do - work out when the risks are significant and take it then.

[HowieUK]

Thanks for all the useful advice everyone!

I will take it when the risk is higher as some of you suggest.

Thanks again

Howie

[iwanttogoback]

Quote

I will take it when the risk is higher as some of you suggest.

I know lots of people don't bother with the meds, but i'm glad that you won't be starting a 'malari - my symptoms' thread.

[HowieUK]

iwanttogoback, on Jun 8 2006, 01:17 PM, said:

I know lots of people don't bother with the meds, but i'm glad that you won't be starting a 'malari - my symptoms' thread.

Thanks IWTGB,

that would be the last thing I would want too!

When I was in India in 1976 I coincidentally 'bumped' into an acquantance from my home City in England. He had malaria and was in a pretty bad state! 'Nuff said'

Howie

[Seventies'Neil]

Warning to travellers on malaria risk

Sarah Boseley
Friday June 9, 2006
The Guardian


People planning to visit countries where malaria is endemic were yesterday warned to take prophylactic drugs by the Health Protection Agency, after 11 deaths last year.

There are around 2,000 cases of malaria in the UK every year, brought back by travellers to Africa and Asia. Of the 11 who died last year, most were not taking malaria tablets or not taking them properly.

Peter Chiodini, of the HPA, advised people to be aware of malaria symptoms, similar to those of flu. "If you become unwell after going to the tropics, passing your travel history to your doctor is crucial," he said.
FULL ARTICLE HERE

[70s-80s overlander]

HowieUK, on Jun 7 2006, 06:52 AM, said:

I will be travelling all over India, North and South for at least a year!

I am a bit worried about taking malaria tablets for that amount of time. Do other long term travellers take tablets for long periods or do they take the risk and forget about them?

Howie

By accident, as usual, I found the answer to the vexing question of
FOR HOW LONG IS IT SAFE TO TAKE ANTI-MALARIA TABLETS?

see http://www.nathnac.o.....prophylaxis c

Q. How long can a traveller take different malaria chemoprophylaxis?

A. Guidelines for the long term use of malaria chemoprophylaxis were published in 2003 by the Health Protection Agency Advisory Committee on the Malaria Prevention (ACMP): Malaria prophylaxis for long-term travellers . Comm Dis Public Health 2003; 6: 200 - 208

The main issues influencing the choice of malaria chemoprophylaxis on a long-term basis are the same as for short-term, i.e. adverse event profile, ease of compliance and efficacy. However, the specific issue relating to advice on chemoprophylaxis for the long-term traveller relates to current licensing restrictions. Long term use of malaria chemoprophylaxis outside licensing restrictions is based on the cumulative evidence of lack of harm rather than positive evidence of safety. This situation is unlikely to change.

Chloroquine

Chloroquine has been taken safely for periods of many years at doses used for malaria chemoprophylaxis. However, there has been concern expressed about the possible development of retinal toxicity with long term use of chloroquine (or hydroxychloroquine, often used to treat rheumatologic disorders). Retinal toxicity has been described in those on daily chloroquine dosage for rheumatic disorders. As a result, two thresholds for the risk of retinopathy have been suggested:

* A total cumulative dose of 100g of chloroquine base
* A daily dose of 250mg base (4mg / kg) (Luzzi, 1993)

The first threshold would require an adult to take chloroquine continuously, weekly, for a period of six years. The second threshold is far in excess of the prophylactic dosage. It has been concluded that the risk of retinopathy from prophylactic dosage alone is negligible (Hill 1995). Further reassurance can be gained from the fact that retinopathy has only rarely been reported in patients taking weekly prophylactic dosages (Luzzi, 1993; Lange, 1994)

ACMP advice suggests that chloroquine can be taken on a long-term basis. However, physicians should consider a baseline ophthalmologic examination for those who will be taking the drug long-term and then every 6 – 12 months, starting when they have been on chloroquine in prophylactic dosage for a cumulative period of 5 years.


Proguanil

There is no time limit specified for the use of proguanil. Therefore, it can be taken continuously for several years.

Mefloquine

There are few data on the use of mefloquine for periods exceeding two years, although there is no evidence of cumulative toxicity, and mefloquine taken for over 1 year is well tolerated. The product licence suggests mefloquine can be taken continuously for a period of up to 12 months. However, advice from the ACMP indicates that there is no evidence of harm in long term use if the drug is tolerated in the short term, and suggests that mefloquine can be used safely for up to three years in the absence of side effects.

Doxycycline

Doxycycline is licensed for up to two years or more in the treatment of acne in the same dose as is used for malaria prophylaxis. The ACMP have concluded that there is no evidence of harm in long-term use of doxycycline and it may be taken safely for periods of at least up to two years.

Atovaquone / proguanil (Malarone®)

Both components of Malarone® have been used individually on a long term basis, although there is little experience of long-term use of the combination. Many countries do not restrict the length of time Malarone® can be taken although the UK product license states it can only be taken for travel up to 28 days. Advice from the ACMP concludes that there is no evidence of harm in long-term use and suggests that it can be taken confidently for travel up to three months, and possibly up to 6 months or longer. There is a report of Malarone® use for periods from 9 to 34 weeks, in which there was no excess of adverse effects and no appearance of unexpected adverse effects (Overbosch 2003). Nevertheless, long-term use of Malarone® should be prescribed with careful consideration until additional post licensing experience is available.

References

Luzzi GA, Peto TEA. Adverse effects of antimalarials. An update. Drug Safety 1993; 8: 295 - 311.

Hill DR. Issues for long-term and expatriate travellers. In: Cook GC, editor. Travel Associated Disease . Royal College of Physicians, London: 1995. p 101.

Lange WR, et al. No evidence of chloroquine-associated retinopathy among missionaries on long-term malariachemoprophylaxis. Amer J Trop Med Hyg 1994; 51 (4): 389 -92.

Overbosch D. J Trav Med 2003 Suppl 1:S16-S20, discussionS21-S23.

[H.Nick]

...That is really useful information!

Malc... a blood test for malaria is quick and simple, you will have your answer in a couple of hours.

[susanj]

So to continue on this thread, I'm going to be in Delhi for 2-3 days at either end of my trip (away all of August) in Himachal Pradesh the rest of the time, even my Doc thinks I only tablets either side of being in Delhi not when I'm up North. Any thoughts?? Also the cost in the Uk of these tablets is approx £64 fro 22 tablets OUCH

Suze

[kullukid]

I haven't bothered with them on my last 2 trips mainly because I was in the Himalayas where malaria mossies can't survive. I also spent 2-3 days in Delhi at either end of my trip, but I had a room with a very strong fan which definitely keeps them away you can also get a mossie coil to burn in your room which I didn't bother with, but I can honestly say i've never been bitten (bad blood!) not even in the south (that's the south of India not the south of me!) . But this is definitely a personal choice thing. KK

[H.Nick]

Face it, kullukid: Mossies just don't like you

Some of us are more popular...

Unfortunately

[WonderWomanUSA]

Quote

I'm going to be in Delhi for 2-3 days at either end of my trip (away all of August) in Himachal Pradesh the rest of the time, even my Doc thinks I only tablets either side of being in Delhi not when I'm up North. Any thoughts?? Also the cost in the Uk of these tablets is approx £64 fro 22 tablets OUCH

Price depends on what tablets you're buying, Susan. Doxycycline is easily and cheaply available in and out of Delhi, and it sounds like you'd only need a couple of weeks' worth, to cover you in Delhi.

If you'll be above 6500 feet, according to the CDC, you won't need anti-malaria meds; see http://www.cdc.gov/t...ia/indianrg.htm for more info.

[nokey]

Quote

Mefloquine

There are few data on the use of mefloquine for periods exceeding two years, although there is no evidence of cumulative toxicity, and mefloquine taken for over 1 year is well tolerated. The product licence suggests mefloquine can be taken continuously for a period of up to 12 months. However, advice from the ACMP indicates that there is no evidence of harm in long term use if the drug is tolerated in the short term, and suggests that mefloquine can be used safely for up to three years in the absence of side effects.

Hi
I am traveling to India in september for 3 months .My doctor has suggested and prescribed lariam tablets for my trip.
Was checking them out on a medical website and it states there are quite a few side effects.
Has anyone taken these tablets or suffered any side effects from taking them.

[iwanttogoback]

nokey
the subject of malaria medication is one guaranteed to get a million different responses.
my view is:
1. malaria is potentially fatal and therefore not to be ignored;
2. there are a number of medications available, all of which have some side effects; sl
3. you need to research the options and make your own mind up.

for me, because I have had issues with anxiety and depression in the past I am not willing to take any medication that lists these as a possible side effect so lariam was out. I ended up taking doxycycline because, for me, it seemed to be the least damaging. (and it meant I had to have lassi at every possible opportunity )