Best anti-malarial and mosquito defense?

April 7, 2005 5:40 AM

I'll be travelling soon in east Africa, and I'm trying to figure out which anti-malarial medication is "best" (based on effectiveness, side-effects, etc). Anyone have experience or suggestions? Also, I'm curious about some of the new clothes I've seen (i.e. BuzzOff from Ex Officio) that are impregnated with permethrin...are these worth the money?
posted by abingham to travel & transportation (30 comments total)

Here's my experience. I went to Tanzania for a month last year and took Atovaquone/proguanil (brand name: Malarone). It's a once a day pill and I had no problems with it at all. My co-worker went to TZ two years before and took Mefloquine (brand name Lariam) and had UNBELIEVABLY horrible side effects from it. (It's a once a week pill) They warn you that you might have "vivid dreams" and "visual disturbances". She had these and she also developed terrible anxiety. Anything and everything scared her for about a year and a half and she would have problems with her heart racing. Her husband took the same drug and he had a lot of problems with vivid night terrors even after he returned home and stopped taking the pill. They both took Malarone when they travelled a few months ago and had no problems at all. I highly recommend Malarone over Lariam.
posted by SheIsMighty at 6:03 AM on April 7, 2005

I'd also stay the hell away from Mefloquine. It's unpredictable -- I used it without incident several times, and then this last time nearly went psychotic. I've also heard that most strains of malaria are resistant to Mefloquine. This may or may not be the case.

Most of the folks I talked to about this said they simply took their chances with catching malaria. Some of them carried a combination therapy of Fansidar & Cotexcin, although I don't remember the dosages. The idea was they'd take this combo if they actually caught malaria, to stall for time.

I have nothing to say about BuzzOff (having never used it), but the other ExOfficio stuff I've owned has performed exceedingly well during a year of fairly hard travel around the world.
posted by aramaic at 6:31 AM on April 7, 2005

You really should go to a reputable travel clinic. They have physicians who track the strains of malaria, and can recommend one version over another for specific locations. Having said that, I took Lariam once and don't recommend it if you have a choice. I just stopped taking it, and decided that I'd risk it because the side effects were far too great for me. There are various side effects for all of them, and depending on your personal allergies, other medications, and the actual location you'll be, the travel clinic will recommend one over another. You don't say where you are, but this is a directory for travel clinics in the US. If you're not American, ask your physician or at a university for the best travel clinic. As for the clothes, I've always just done it by using the precautions that seemed most widely used: staying indoors at dusk when the problem seemed worse, tucking pants into socks, using a good spray if necessary, sleeping under a properly used mosquito net, long sleeves, not reeking of BO after a long day, burning citronella candels if appropriate. Or, you can just bring me along: I seem to attract all the bugs in the area, so just leave me outside as a decoy and you'll be bug free!
posted by fionab at 6:32 AM on April 7, 2005

Huh. I was just about to speak up in favor of Larium (mefloquine), which I took once a week in Kenya and had no side effects at all. My biggest complaint is that it gives you a horrible aftertaste, but at just once a week you get over it. I could never understand how people had such a different experience than I did, with night terrors and panic attacks and whatever. But I guess that's how it works. To be fair, the incidence of serious side effects is about 1 in 20,000*, it's quite a phenomenal coincidence that 2 people in the same party both had problems.

As for permethrin-impregnated clothes, I wouldn't bother if they're super expensive (I've never seen them). At local shops in Kenya and Tanzania, you can get coils / cones of pyrethrum extract for 50 cents that burn for about 8 hours, so depending on how long you're staying, it would probably be cheaper to just burn some pyrethrum every night you spend outdoors (shouldn't need it indoors, esp in urban areas). Do make sure you have a mosquito net on your bed, however.

* "The World Health Organization puts the incidence of serious neuropsychiatric effects from the drug at 5 in 100,000. Many experts believe these figures are low and that as many as 25% of all users experience some side effects." And this comes from a plaintiffs' attorney's website, so I'm skeptical about the "experts" mentioned. Plus "some side effects" are way different from "serious neuropsychiatric effects".
posted by rkent at 6:36 AM on April 7, 2005

I would recommend you make your way over to the thorntree, at Lonely Planet. Click on the "health" branch and read the sticky thread second from the top.

If you want anecdotal reports, I took mefloquine (Lariam) for 6 months while traveling, and had no problems (beyond some excellent and extremely sexy dreams). I've also used doxycycline and it was fine too, though I did get sunburns more easily. My partner was in Chad for several months last year, and decided to take nothing - but she was working with a medical organization and had access to treatment.
posted by Cuke at 6:39 AM on April 7, 2005

I was on Lariam when I was in South America and I wouldn't recommend it. It disrupts your normal thinking patterns and causes hallucinations. I used to get the craziest dreams the night I took the pill (its a once-a-week thing) and the next day I could "dream" while looking at a wall or other large, flat surface. It was fun to see all those crazy patterns but also frightening. I would find an alternative anti-malarial.

There was a story about an army base south in the US (Fort Drum I believe) where a group of soldiers were given Lariam upon returning from where-ever they had been stationed. Soon after returning there were three separate incidents of them killing their wives and then themselves. All were attributed to Lariam.

Have a great trip though! I'm jealous!
posted by LunaticFringe at 6:48 AM on April 7, 2005

My best friend goes to Indonesia every year to do research, and last year took Lariam for the first time. She said the night terrors and anxiety were horrific, and it lead to a brief depression that lasted for a few weeks after she stopped taking it. More anecdotal evidence, but I hear frequently about side effects from people I know who've taken it, so it seems like the numbers don't quite match up to my experience. However, I have never taken Mefloquine.
posted by annathea at 6:49 AM on April 7, 2005

As fionab said, your choice in medication is limited by the locations you wish to travel. At the pharmacy here in South Africa there is a chart which shows which to use where. Whether the chart is properly up-to-date, I can't say, and fionab's words give me caution (thanks!). I live south of malaria country, but expect to travel to Kwazulu-Natal and Kruger Park.

If the mosquitos up there are anything like down here, expect some amusement. They are weak and the slightest breeze blows them away. But they are also very quiet and you won't hear them buzz like American mosquitos. Also slow, you can snatch them out of the air effortlessly. Ha, Wisconsin mosquitos would eat them as snacks.
posted by Goofyy at 6:50 AM on April 7, 2005

As an alternative to Lariam (my doctor was worried it would interact with my antidepressant) I was prescribed tetracycline as an anti-malarial prophylactic. The downside is that it might cause your skin to become more sun-sensitive, and you have to take it every day. But it's inexpensive (surely a concern if you don't have health insurance) and, well, I didn't get malaria, so I guess it worked!

Fun fact: apparently, the gin&tonic was the original anti-malaria "treatment."
posted by elisabeth r at 6:55 AM on April 7, 2005

This CDC page has some coverage for resistant locations - click on the countries that you're going to, and it will give you some idea about what to ask your doctor. Please remember that this is from 2003 - 2004, so the data may have been collected even earlier than that. As I recommended above, a trip to an up-to-date travel clinic is the best policy.
posted by fionab at 7:21 AM on April 7, 2005

I'd second a travel clinic. Different areas of the world have both different species of malaria, and different levels of resistance to the common anti-malarials. East Africa will be very different from South America and Indonesia.

On preview: great link, fionab.
posted by gramcracker at 7:22 AM on April 7, 2005

Fun fact: apparently, the gin&tonic was the original anti-malaria "treatment."

Was and is no more. Modern-day tonic water does not have enough quinine to be effective.
posted by jbrjake at 7:22 AM on April 7, 2005

I second what fionab says --- and most major hospital groups have their own dedicated travel clinics with staff who deal only with travel related preventive care. The travel clinic staff at my clinic will even pull State Dept. related briefings on the area(s) you're planning to travel to. (First question asked when I was going to the Philippines was, "You're not going to Mindanao, are you?")
posted by nathan_teske at 7:25 AM on April 7, 2005

The CDC on malaria is interesting too -- it may seem slightly alarmist to the Western eye, but remember that malaria is still a massive problem around the world. It's worth a look so that you can recognize the signs while travelling; ask your doctor about taking treatment doses along with you - especially if you'll be far from any kind of medical help.
posted by fionab at 7:25 AM on April 7, 2005

My travel doctor also gave me a prescription for Cipro to take with me just in case I drank the water over there. I didn't have to use it, but it was nice to know I had it.
posted by SheIsMighty at 7:33 AM on April 7, 2005

I took larium as a Peace Corps volunteer in Africa--would never take it again. I experienced the crazy dreams, edginess and also some depression, although some people reported no side effects. My husband took doxy because of a pre-existing medical condition and did fine with it, although taking a daily antibiotic for two years lends concerns of its own.

I reiterate the advice to talk to a doctor who is experienced in tropical diseases. If possible, start taking your meds a couple of weeks before you leave to get your blood levels up to a therapeutic point and also, if you go the larium route, to see if there are any immediate effects.
posted by handful of rain at 7:40 AM on April 7, 2005

Hopefully the responses aren't biased to those getting negative experiences, so the data posted by rkent may be worth looking into. As another anecdotal point, I took Mefloquine with no side effects whatsoever. None.
posted by whatzit at 9:03 AM on April 7, 2005

I am not a doctor, just a biology student heavy into microbes, viruses, infectious dieases.

My advice:

1. Go to a travel clinic.
2. Do not take mefloquine. Although I do not discount the experiences of the mefites here who took it without apparent side-effects, I would suggest that the prevalence of psychotic incidents is higher than the CDC's estimate. The problem is that mental sideeffects, by their very nature, may not be apparent to the user; esp. if you are travelling alone, you are at risk for behavior that could get you in serious trouble.* On sum, mefloquine is certainly not worth the risk, especially when the best prophylaxis in endemic areas are bug nets esp. at night, limiting exposure during dawn/dusk, wearing long-sleeved shirts and pants, and using bug juice.

* (My best-friend's sister did a Peace Corps-type posting in west Africa and had to be evacuated after another participant, taking mef, had a psychotic incident and, tragically, killed his host father + brother.)
posted by docgonzo at 9:46 AM on April 7, 2005

I was on Larium in Calcutta for 3 months and was fine. I do remember the Europeans working with me didn't even get the option of that drug b/c of the risk of side effects, so they took an annoying one-a-day. As for why I wasn't disturbed by the Larium, I have no idea. I may have a high tolderance for drugs as my recent wakings during oral surgery procedures where I was supposed to be completely out, can testify to.
posted by scazza at 9:48 AM on April 7, 2005

When I was in South East Asia last fall I was offered three different types of Malaria pills, the one with the least symptoms was Malarone.

It was more expensive at about $5cdn a pill, but only needed one pill a day (with a meal). Was very satisfied with it, heard horror stories by some people that took Larium.
posted by furtive at 10:12 AM on April 7, 2005

As for why I wasn't disturbed by the Larium, I have no idea.

That's the evil thing about Lariam -- it sneaks up on you. I took it for years with no ill-effects, and then *bang* on one occasion I went completely insane, in a foreign country, by myself, in the "bad" part of town. Not so much fun.

Prior to that event I would have been skeptical of the horror stories. Now I realize how true they were, and how completely unpredictable that drug is. I'll never take it again, because I wouldn't be able to rely on my sanity.
posted by aramaic at 10:20 AM on April 7, 2005

To leech onto this question, what good mosquito repellants are there? Are there any that work indoors? Is there a safe alternative to a mosquito net for sleeping at night? (Assuming American, non-deadly-virus-containing-mosquitos?)
posted by sirion at 10:34 AM on April 7, 2005

Another vote in the stay-the-hell-away-from-Lariam column. I've personally run across a half-dozen awful stories of hallucinations and other disturbing psychological reactions - my wife is one of them, she felt a deep, numb detachment from her surroundings for several weeks, and discontinued use because of it - and all the anecdotal evidence points to the fact that the official numbers are way off. It's a nasty drug.

(One of the tricky things with psychological side effects is that it's very difficult to prove unequivocally that the drug caused the side effect. Maybe it was food poisoning or heat stroke or culture shock that made your mind bend, you know? See, for example, the mountain of anecdotal evidence that the birth-control drug Depo Provera causes massive emotional trauma vs. the official line that "some" users "may" suffer "mood swings.")

If you're going to be in an area where malaria is prevalent for only a couple of months or less, then taking doxcycline might be your best bet. You really don't want to be taking an antibiotic daily for any longer than that, though.

Anecdotally, I can tell you that a friend of mine who was a TV news bureau chief in India for a number of years swore by an herbal/holistic antimalarial, as did many of his colleagues (he said). It can't be advertised as such for the usual herbs-aren't-medicine reasons, but if you go to a naturopath and ask for an antimalarial, they give you these little pills that you take once every couple of months (IIRC). Only contraindication is you can't eat mint the week you take 'em. Ask a doctor at a travel clinic, and he'll go into some detail about placebo effects and such (at least mine did), but who knows? My wife and I took 'em for awhile in India ourselves, though we were very infrequently in malarial areas anyway.

I've also known people who've spent months on end in malarial parts of India who get by on a sort of "rhythm method": stay indoors at dusk, sleep under a mosquito net, soak yourself and your clothes in DEET if you're heading out at a time of day when mosquitoes are about. This requires a pretty intimate knowledge of the biting habits of local mosquitoes wherever you are, however.
posted by gompa at 10:36 AM on April 7, 2005

I also took Malarone with no noticable side effects. My insurance company covered the cost.

I wouldn't bother with the clothing for a different reason than mentioned above: I found that I prefered to wear clothes I bought in Africa (Ghana) because 1) they were more comfortable and 2) they identified me as someone who had been in Ghana long enough know how to negotiate a good taxi price etc.

My friend took an antibiotic that was viable in our area as an anti-malaria drug. She didn't get malaria, but she did get some kind of wierd fungal infection that has been rather debilitating for the past few years. I'm not sure if the two are connected, but considering that antibiotics increase your chance of a yeast (fungal) infection, I personally wouldn't chance it.
posted by carmen at 11:13 AM on April 7, 2005

I took Lariam / mefloquine. Didn't go psychotic, but it gave me intense nausea all the time. Your mileage may vary.
posted by randomstriker at 11:54 AM on April 7, 2005

Another non-horror story concerning mefloquine: I traveled in Kenya (and Tanzania) for about five weeks almost ten years ago and took Lariam. Except for the aftertaste (see above) I experienced no side effects whatsoever.

I'd strongly recommend talking to an expert about resistances and what drug to take.
posted by amf at 1:05 PM on April 7, 2005

Interesting thread. I traveled in Tanzania and Kenya in the late eighties on a college trip. I vaguely remember taking Lariam. I sufferted no ill effects but one girl on the trip killed herself shortly after we got back. I wonder now if that was related to the anti-malarial.

Another girl died returning from a trip to West Africa. Same college. I wasn't on the trip, but knew the people leading it. The cause was malaria, so it is serious business
posted by vronsky at 8:27 PM on April 7, 2005

i have travelled extensively through africa, and lived in rural tanzania for three years.

do not take larium, in my experience appx 1 in 4 have side effects so serious they have to stop taking it. interestingly the peace corps were almost all on it, but they were just given the tablets - i showed them the medical notes that came with the package, which clearly said you should not take it for longer than three months..... they were on it for two years. a couple of them did have complete nervous breakdowns and another killed himself.

i have never had malaria, here's how to lessen your chances of it.

1, wear appropriate clothing (long sleved shirts, long trousers) cover up before dusk, do not wear sandals
2, use deet or something similar on your exposed skin
3, light a couple of mosquito coils each evening

the last time i was in the village i worked in, there was a malaria epidemic and a quater of children under 5 died in three months. horrifying
posted by quarsan at 9:07 PM on April 7, 2005

My girlfriend at the time and I both took Lariam in South East Asia years and years ago. Neither of us had unpleasant side effects (although I did have some gnarly dreams), but we did meet other travellers who had or were having trouble with it.
posted by stavrosthewonderchicken at 10:37 PM on April 7, 2005

East Africa travel tips:

You can get a spray bottle of permethrin and spray your own clothes. I think this is much cheaper than buying a bunch of new clothes. I got a bottle of it, but the whole idea of something that kills insects on contact being in contact with *my* skin for 6 weeks was too much for me to take and I wound up never using it. This was a mistake; I should have at least done my socks.

Because malaria is not the only thing you have to worry about. The tumbu fly is a little thing that lays eggs in your clothes as they are drying. When they hatch, the larva burrow into your skin. You can find out more here. Anyway, I got one of those suckers in the bottom of my foot, but I didn't realize what it was until it died in there, and... yeah. The permethrin is a good idea if only for that reason.

You're going to take some anti-diarrea stuff (if you have half a brain) but make sure you take pepto bismol instead of (or in addition to) Immodium AD. Immodium AD just binds you up and locks all of those nasty bacteria in your colon until it wears off. The Pepto firms up your stools a bit but still allows you to go. So you want to pack as many chewable pepto bismol tablets you think you can get away with, and start taking them according to the directions on the box at the first sign of serious stomach cramps. I was able to handle everything with Pepto combined with a prescription for Cipro (ask your travel doctor about it and ask for a 'script; basically one Cipro pill knocks out nearly any diarrea causing nasties in your system.)

As for anti-malarials, I'll put in another vote for Malarone.
posted by the_W at 7:19 PM on April 15, 2005