Malaria Medication

[iloveglee]

I am seeking opinions about taking malaria prophylaxis for a short trip to the amazon in brazil. i have read much about the risks/lack of risk of contracting the most dangerous type of malaria. we will be having 3 days in manaus, and 4 days on a cruise, with side trips from the ship. we definitely plan to use deet repellent, most of the research i have read suggests this is perceived to be dangerous, but actually is not. also covering up clothing wise. our friends (brazilian) who we are travelling with have seen their own doctor who does not recommend the medication due to the nasty side effects. also, i understand manaus and the rio *** where we are cruising is not especially risky for mosquitoes due to the acidity of the water. i have heard some pretty scary stories about the different types of medication available, some worse than others. if there is anyone out there who has travelled in the amazon, in the way we are doing (quite a luxury ship), what are their views about malaria prevention. i understand none of the medications are 100% effective anyway.

[237SJ]

I haven`t taken an anti malaria tablet for about 20 years. Just make sure you use a deet spray and make sure you use it during the day because the mozzies that spread the zika virus bite during the day

[Buenchico]

Here's the only 'official' source of information (backed by the Foreign & Commonwealth Office):
http://travelhealthpro.org.uk/country/34/brazil#Malaria

You'll see that it states:
"There is a risk of malaria in the Amazon basin of Brazil, including in the city of Manaus: atovaquone/proguanil OR doxycycline OR mefloquine recommended".

So it would certainly seem wisest to use one of the three anti-malarial medications indicated, leaving it to your GP to advise on which might be best for you.

[KARL]

The decision must be yours but I do understand your reservations and those of your fellow travellers. I have never been to Brazil but I have spent quite a few years in malarial countries/areas. I took anti-malarial medication for the first few weeks but then stopped (unpleasant plus unknown long term effects - as you say, only reduced risk of infection) and my wife and young children did not take any either once they joined me. None of us ever got malaria. The European medical profession (UK included) will no doubt strongly advise anyone going to any of these places to take the medication - that is what they must do for fear of being criticised.

To risk getting malaria one must be bitten by an infected mosquito. What my family and I did was to wear long sleeves and trousers when (rarely) out and about between dusk and dawn (including eating out, etc.), together with a good mosquito repellent (Mosquito Milk it was called, no longer available I believe, Avon's Skin So Soft I think it is called that is said to be very effective) applied on the forehead, cheeks, behind ears, all around the neck and at wrists and ankles plus a strip down the trouser legs for good measure.

We used a good insecticide (Baygon is the best) in the accommodation - a continuous strip of spray all around windows and doors, into ceiling corners, and under beds and other furniture (every evening without fail if in other places than our own home) and kept windows and doors closed. If you have access to a good bed net then use it.

[jno]

I'd be wary of mefloquine, which has been known to cause psychotic eipsodes

[mikey4444]

Larium is also very suspect.

[rockyracoon]

Read your insurance terms and conditions. They might not cover you if you haven't taken the medication and you contract malaria.

[iloveglee]

i think mefloquine and lariam are the same, and yes I have heard they can cause psychotic episodes. I am leaning toward doxycycline because I have taken it before for a bad sinus infection. it can cause a bit of an upset stomach but is just about tolerable and is a well known antibiotic that has been around for a long time. its a good point about travel insurance, which hadn't occurred to me. they could quite easily refuse your cover if you knowingly don't do what you can to prevent illness. the fellow travellers doctor has recommended hepatis A vaccine, which I can understand due to unknown hygiene practices, but also hepatitis B, which I body fluid borne?? on balance, maybe we should take it - the malaria thing that is

[atalanta]

One of the known side-effects of Lariam is death.

[jno]

yes, Lariam is mefloquine. Some people are fine with it, but so many are not, and the possible side effects so severe, that personally I've always given it a wide berth.

[iloveglee]

thanks for all the insights. we are fairly certain that lariam is definitely off the menu. from the stuff i have read doxycycline on balance seems to be the one with the least worst side effects, apart from the risk of photosensitisation which wont be an issue for us. i have also read that there are two kinds of doxycycline, one of which is slightly more tolerable than the other (also more expensive but if needs must). does anyone have experience of this. even though we are in the uk, our health service wont pay for medication for this kind of reason. but having spent a great deal of money on a trip to brazil, and an amazon cruise, the cost of a few tablets has to be put into context.

[campbellking]

I've taken the malarone tablets on several trips to Africa with no ill effects. Your practice nurse should be able to advise which tablets are best, but certainly I would avoid Larium.

[iloveglee]

has anyone any experience of doxycycline. i understand that it comes in more than one format, one of them more tolerable.

[Peter Pedant]

yeah I took Larium when I went to Viet nam

as a malariologist said ' if you get chloroquine resistant malaria you will die'

and I have to say it was pretty unpleasant - thought I could fly so wished er to jump off a building and also something called jamais vu
https://en.wikipedia.org/wiki/Jamais_vu
which kinda made getting back to my hotel ( er 20m away) difficult - 30 min exercise

I also had it running on Blackstone edge and couldnt refind my car ( think wuthering heights in a singlet and shorts )

so the choice is yours

I would do doxy myself

[donny48]

We have used Malerone for years with no ill effect it is quoted as being good for the Amazon region under its other name
tovaquone with Proguanil is the generic tablet form of Malarone and is therefore exactly the same but cheaper. ... "Atovaquone with Proguanil is very effective at protecting against malaria." ... Atovaquone with Proguanil (generic of Malarone) helps to prevent mala
One of the symptoms of malaria could be death, do you want to risk that.

[Peter Pedant]

I asked a fren who went up the amazon

Lariam she didnt like and doxo she did

[iloveglee]

i think from everything i have read, the answer is that pretty much anything is preferable to malaria, except perhaps the psychosis from larium. on balance, i am pretty sure we will take doxycycline, this is suitable for the amazon, the one with the least side effects is not suitable sadly because of resistance. nevertheless prevention is also better than cure, so loads of repellent and long sleeved/legged clothing. good thing we are only going to be there for a week, otherwise the heat might kill us first