Thursday, 20 December 2007



How organized we are, getting ready to head off to Asia at the end of Janauary... but we're having real trouble deciding which malaria medication to take, and how much to buy. Mainly because we don't know exactly where we're going and for how long.

We don't fancy spending huge (and we mean huge) amounts of money on a 6 month course of Malarone, but we also want to be safe.

From what we can gather so far, most places are pretty safe unless you go off the beaten track - so safe in fact that most travellers don't bother with any medication, just using repellant and covering up in the evenings. To the best of our knowledge, genuine high risk areas are Lombok, and possibly also bits of Cambodia and Laos.

If anyone has any realistic advice about malaria risk in Indonesia/Asia/India, and what to do about it, please leave us a comment.



Anonymous said...

I think you know that you need different medication for different areas. I can't help you make the decision but do make sure you check the possible side effects of any medication. I gather that some are really not much fun.
happy decision time

Anonymous said...

Hello there,

My name's Ingrid, I'm a friend of Phil (Mel and Phil whom you visited in Dunedin, NZ). I've been following your travels around the globe with great envy and mostly awe - I'm hoping to do the same in a few years' time.

I live in South Africa and am by no means a doctor, but know a little about Malaria and the drama surrounding choosing the right pills. I did a little research just to refresh my memory and to be sure to give you the correct names for things, so here goes....

Basically, the are four types of Malaria (P. falciparum, P. vivax, P. ovale and P. malariae) of which the 'Plasmodium Falciparum' parasite is the most dangerous one that can kill you. This is the one you want to try and avoid.

The most commonly used drugs and their pro's and con's are as follows:

Mefloquine - used more for treatment than for prevention and side effects include paranoia and nightmares. If you are prone to depression and that kind of thing, this might not be a good option. Some virulent strains of Malaria are also resistant to Mefloquine in Thailand, Cambodia and Myanmar.

Malarone - less side effects than Mefloquine, but way more expensive as you probably are already aware. It can be used for both treatment and prevention, but again, some strands are resistant in some parts of the world.

Doxycycline - should be used for prevention rather than initial treatment of Malaria, as the effect of the drug on the body is delayed. It heavily impairs the effectiveness of hormonal contraception (so don't use it if you are on the pill) and most common side effects with long term use include photosensitive skin reactions.

Chloroquine - usually used in combination with Proguanil and is only used to prevent the less-harmful types of Malaria. It's not very useful, because it doesn't have any effects on P. falciparum Malaria.

Quinine - has quite hectic side effects and is advised NOT to be used as prevention, but rather only as a cure. It fights P. falciparum Malaria.

The question about which of these drugs you want to take, and if you want to take any at all, still remains. So let's propose you go on your travels and you don't take anything. Halfway through, you contract Malaria and you go to a hospital for treatment - the first thing they will have to do is figure out which type of Malaria you have. If you have P. falciparum Malaria, you will have to be hospitalised, where the other types might just require you to take some drugs. They also need to know where you got the infection in order to figure out the drug-resistant status of it.

Let's say for argument's sake you were taking Malarone all along and you STILL get Malaria, that means that they can save time, eliminate the types of Malaria you don't have and proceed with the appropriate drugs immediately.

I don't know what type of medical care will be available to you when you are there, so you might want to take that into consideration. And if you do get sick and have to go to a hospital, insist on seeing a specialist on Tropical Illnesses - not all doctors know how to look for the different types of Malaria. In areas where Malaria is not endemic (like the USA and the UK), it might prove quite difficult to find such a specialist.

Alternatively, you could also just throw caution to the wind and just try and keep the mosquitos off your skin as far as possible. And then, as soon as you get symptoms like fever, shivering, joint pain, severe headache or vomiting (and these symptoms don't include hangovers!), get yourself to a doctor a.s.a.p. Monitor any mosquito bytes you might get - symptoms usually occur 6-14 days after infection, but can take as long as a year to show its face. Like I said, it's very important to know in which country or area you got infected.

I can recommend having a look at the following link: (Centers for Disease Control and Prevention website). It explains everything in much more detail there.

As a South African, we tend to be in and out of the Malaria areas quite often, so taking the drugs is really more of a hassle to us than anything else. We also have a lot of specialists that are very familiar with Malaria and its symptoms. However, you guys come from a country where there is no such illness. Your bodies aren't even vaguely resistant to catching this kind of thing and you will only be exposed to it for a few months while travelling. If I were you, I would rather take the drugs, feel a little poorly for a while and live to tell the tale...

I hope all of this helped. Best of luck with all your travels and stock up on the Mozzie cream!

Ben and Debs said...

@Ingrid: w00t! You win the prize for the longest comment ever!

Thanks very very much for the detailed information - extremely useful stuff! I think we're going to use Malarone for the high risk malaria regions, and Doxycycline for the lower risk bits... and use hardcore repellent/avoidance techniques all the time.

Fucking mosquitos.