Malaria Tablets
Discussion
Off Sierra Leone for work. All jabbed up and a stock of Malaria tablets (Atovaquone Progunil) but having shelled out £120 for the tablets, I'm now getting conflicting reports as to their worth.
Some seasoned travellers to that part of the world have suggested they are useless and best course of action is to avoid getting Malaria but if I do, get treated there as they'll know the strain.
I'm only going to be based in Freetown - no traipsing through the jungle!
Any pointers / experience gratefully received.
Some seasoned travellers to that part of the world have suggested they are useless and best course of action is to avoid getting Malaria but if I do, get treated there as they'll know the strain.
I'm only going to be based in Freetown - no traipsing through the jungle!
Any pointers / experience gratefully received.
I spent about 10 years in west and central Africa. I initially took pills for a couple of years, but was 'advised' by colleagues that if there long term it was best to just get treated as needed. I then got malaria twice in 1 year, treated with artesimin based drugs that are not normally available or licenced in the UK.
Unless you are going to be there 10 years or more I would take the pills. I assume that the Doc or nurse who prescribed the proguanil checked that it was reasonably effective there? I would also start taking it a fair bit before you leave, it gave me mouth ulcers, so I moved to doxycycline, best to find out before you go so you can look at alternatives.
If you chose to not take pills then you could get treated ok there, so long as you go straight to a doctor, as it can kill in 24 hours. When you return to the UK treatment is not as easy as clinicians do not see many cases, a hospital may be needed to do the blood film(s) for diagnosis, and the range of drugs is more limited.
Whatever you do, use nets, and take a spare plus some drawing pins in case there is no net, even if there is a/c; Mozzies do hide in the a/c unit. Use repellants, and cover legs and arms from early evening. You'll still be bitten but hopefully less. Everyone thinks of malaria but do also be aware of the symptoms of any other Mozzy borne illnesses such as Dengue fever, if present in the area.
Enjoy the trip, it is worth the time preparing so you don't get sick if possible.
Unless you are going to be there 10 years or more I would take the pills. I assume that the Doc or nurse who prescribed the proguanil checked that it was reasonably effective there? I would also start taking it a fair bit before you leave, it gave me mouth ulcers, so I moved to doxycycline, best to find out before you go so you can look at alternatives.
If you chose to not take pills then you could get treated ok there, so long as you go straight to a doctor, as it can kill in 24 hours. When you return to the UK treatment is not as easy as clinicians do not see many cases, a hospital may be needed to do the blood film(s) for diagnosis, and the range of drugs is more limited.
Whatever you do, use nets, and take a spare plus some drawing pins in case there is no net, even if there is a/c; Mozzies do hide in the a/c unit. Use repellants, and cover legs and arms from early evening. You'll still be bitten but hopefully less. Everyone thinks of malaria but do also be aware of the symptoms of any other Mozzy borne illnesses such as Dengue fever, if present in the area.
Enjoy the trip, it is worth the time preparing so you don't get sick if possible.
Edited by Biggles111 on Wednesday 2nd November 21:03
. Most of the guys are using maralone, but they get this through health care providers (USA)StevieBee said:
Cheers Biggles. Good advice.
I'm there only next week but back in the new year for a 10 day trip.
Been taking the tablets for a couple of days and no side effects yet . Given I've spent £120 of them, I may as well used them!
Lived in Zimbabwe, went up through the Zambezi valley (malaria central) a couple of times, first couple of times I used tablets. Let me just say I had to wear nappies. After that I was just going to get treated when I caught it, never caught it.I'm there only next week but back in the new year for a 10 day trip.
Been taking the tablets for a couple of days and no side effects yet . Given I've spent £120 of them, I may as well used them!
Then other strains, like cerebral malaria, so would re-think about the pills.
I found vitamin B and tabard were good.
StevieBee said:
Off Sierra Leone for work. All jabbed up and a stock of Malaria tablets (Atovaquone Progunil) but having shelled out £120 for the tablets, I'm now getting conflicting reports as to their worth.
Some seasoned travellers to that part of the world have suggested they are useless and best course of action is to avoid getting Malaria but if I do, get treated there as they'll know the strain.
I'm only going to be based in Freetown - no traipsing through the jungle!
Any pointers / experience gratefully received.
Take them, and use a mosquito net and insect repellents as well would be my adviceSome seasoned travellers to that part of the world have suggested they are useless and best course of action is to avoid getting Malaria but if I do, get treated there as they'll know the strain.
I'm only going to be based in Freetown - no traipsing through the jungle!
Any pointers / experience gratefully received.
I got maralone on a private prescription from my local UK pharmacist when i went to Nigeria last year. Gave me the semi-s
ts (iykwim) for as long as i was taking them but had no other problems.
Unless you're there all the time, take the tablets and use DEET.
I see the cost of them is an issue but i assume you are being reimbursed?
ts (iykwim) for as long as i was taking them but had no other problems.Unless you're there all the time, take the tablets and use DEET.
I see the cost of them is an issue but i assume you are being reimbursed?
I was given doxycycline due to the fact I was in Africa so long. Malarone would have been a better choice but was only allowed to use it for a short period.
All malarial treatment is fairly hit and miss, in my case I got malaria anyway. Treated with chloroquine for a week and sort of cleared up. Came back to the UK and got the shakes and sweats, went to A&E and they were useless, I had to tell them what to do. Get treated over there and cross fingers over here!
As others have said, it is a killer so not something to toy with, cerebral malaria being the worst. Depends on the area.
Africa is an amazing place, enjoy
All malarial treatment is fairly hit and miss, in my case I got malaria anyway. Treated with chloroquine for a week and sort of cleared up. Came back to the UK and got the shakes and sweats, went to A&E and they were useless, I had to tell them what to do. Get treated over there and cross fingers over here!
As others have said, it is a killer so not something to toy with, cerebral malaria being the worst. Depends on the area.
Africa is an amazing place, enjoy
StevieBee said:
Off Sierra Leone for work. All jabbed up and a stock of Malaria tablets (Atovaquone Progunil) but having shelled out £120 for the tablets, I'm now getting conflicting reports as to their worth.
Some seasoned travellers to that part of the world have suggested they are useless and best course of action is to avoid getting Malaria but if I do, get treated there as they'll know the strain.
I'm only going to be based in Freetown - no traipsing through the jungle!
Any pointers / experience gratefully received.
It sounds like you're going to take the prophylaxis from your most recent post - which is absolutely the correct thing to do in your situation. You will have no immunity and falciparum malaria is something that you really don't want (it could kill you very easily) and contrary to the advice you might have received, the last thing you want is to be treated in a hospital there. Should you fall ill when back in the UK a local Infectious Diseases team will be your friends and the suggestion that we don't have a full range of effective medications in the UK is complete nonsense. Some seasoned travellers to that part of the world have suggested they are useless and best course of action is to avoid getting Malaria but if I do, get treated there as they'll know the strain.
I'm only going to be based in Freetown - no traipsing through the jungle!
Any pointers / experience gratefully received.
The GMC says I must disclose my credentials when posting advice as a doc online - I am a hospital consultant and specialise in infections. My advice is to take your prophylaxis (atovoquone/proguanil as prescribed in your case) and do your best to avoid bites. Beware that DEET is good at melting plastics etc so be careful when using it (ate into my G-Shock strap no problem...) If you were to ask me I'd take doxycycline as it is inexpensive and usually well tolerated. Some people do get very bad photosensitivity with it (but not most) so wear sunblock and it can cause heartburn so best avoided taking just before bed/lying down and if you swallow with plenty of water it helps reduce this problem. Maybe something to consider for the next trip.
Hope you have a good and safe trip! It wasn't long ago that the health services there were completely overwhelmed by the Ebola outbreak.
Steve
Edited by DocSteve on Saturday 5th November 22:35
Paul Dishman said:
That's pretty much what I said. Why the preference for doxy over Malarone? Isn't parasite resistance higher for doxy? And G.I. side effects as well as the photosensitivity you've already mentioned?
Well, it's much cheaper for a start and those side effects are not troublesome for most. As for resistance, it depends where you are going but if anything malarone could be an issue (although not likely in S Leone). Doxy, in my experience, is very well tolerated. i used to take malarone but stopped a couple of years back. the general consensus in my office is that no tablet will 100% prevent malaria and they'll only mask the symptoms. much better to be aware of your health and the indicators of malaria and see a doctor if in any doubt. i've been all over africa since no issue. however anti-malarials or not, if you choose to ignore the signs then you are putting your life at risk. one of my colleagues in senegal sadly did just this and went to travel home. he died of cerebral meningitis less than 48hrs of leaving the country.
i was in freetown march and april this year. it was notable as being perhaps my least mossie bitten trip in a good long while but its rainy season now so i guess that will change.
if you're staying at the radisson you will be pleased to know its a very good standard and pretty much mossie free. if not then hard cheese, everywhere else is ropey to average.
my tips would be to get a good deet spray, take vitamin b tablets and keep your hotel room as cold as possible at all times. a mossie net for sleeping is a good investment a hotel ones are usually crap. try to wear long sleeves/trousers at all times. hiking and fishing gear is best for africa.
i quite liked freetown. its a total dump but very friendly people. there are beaches 45min drive from the capital that would take your breath away.
i was in freetown march and april this year. it was notable as being perhaps my least mossie bitten trip in a good long while but its rainy season now so i guess that will change.
if you're staying at the radisson you will be pleased to know its a very good standard and pretty much mossie free. if not then hard cheese, everywhere else is ropey to average.
my tips would be to get a good deet spray, take vitamin b tablets and keep your hotel room as cold as possible at all times. a mossie net for sleeping is a good investment a hotel ones are usually crap. try to wear long sleeves/trousers at all times. hiking and fishing gear is best for africa.
i quite liked freetown. its a total dump but very friendly people. there are beaches 45min drive from the capital that would take your breath away.
Edited by shirt on Sunday 6th November 03:34
Malarone all the way!
I initially took Larium and had some really messed up sleep patterns, I was edgy and couldn't relax.
A colleague took it for years and eventually we caught him trying to cross a gravel car park without treading on any cracks, horrible stuff.
I've been taking Malarone for about 5 years now With no side affects. Just make sure you follow the guidelines properly. A friend died from Malaria mid last year which would have been easily prevented had he not been an idiot.
Dave!
I initially took Larium and had some really messed up sleep patterns, I was edgy and couldn't relax.
A colleague took it for years and eventually we caught him trying to cross a gravel car park without treading on any cracks, horrible stuff.
I've been taking Malarone for about 5 years now With no side affects. Just make sure you follow the guidelines properly. A friend died from Malaria mid last year which would have been easily prevented had he not been an idiot.
Dave!
shirt said:
i used to take malarone but stopped a couple of years back. the general consensus in my office is that no tablet will 100% prevent malaria and they'll only mask the symptoms. much better to be aware of your health and the indicators of malaria and see a doctor if in any doubt. i've been all over africa since no issue. however anti-malarials or not, if you choose to ignore the signs then you are putting your life at risk. one of my colleagues in senegal sadly did just this and went to travel home. he died of cerebral meningitis less than 48hrs of leaving the country.
I realise that you are trying to be helpful but the advice that taking antimalarial prophylaxis will mask the symptoms and therefore you should not take it and be aware of your health is simply wrong in the context of a new traveller to the region. Chronic exposure to malaria parasites allows some temporary immunity to develop so for residents of malaria endemic regions the approach can be different. One of the biggest groups we see with life threatening malaria are those who previously resided in an endemic region then go back to visit relatives etc some time later, after immunity has waned, thinking they can adopt the same attitude. If you are going to a high risk area such as the OP as a traveller you really should take prophylaxis. Healthcare in these regions, in particular Sierra Leone, is poor at best and you don't want a life threatening illness developing whilst you are there. My colleague went out there twice during the Ebola epidemic and one of the challenges was not neglecting the majority of people with feverish illnesses who did not have Ebola but malaria instead. Edited by shirt on Sunday 6th November 03:34
Take an appropriate antimalarial - lecture over!
Edited by DocSteve on Sunday 6th November 12:47
DocSteve....I'm sure you don't need the ego boost but I met a chap working for GOAL in SL who's a Malaria Research Scientist - brain like a planet. I showed him the thread here and he suggested you "know your stuff!"
He also pointed that if you have been prescribed malaria tablets and then choose not to take them and then contract malaria, your travel insurance won't pay out.
He also pointed that if you have been prescribed malaria tablets and then choose not to take them and then contract malaria, your travel insurance won't pay out.
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