Health and safety forum

malaria tablets

  • cj5892

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    is it possible to purchase malarone or doxycycline in bangkok? also what would the cost be (roughly).

    it is going to cost me £20 for my surgery to write a prescription then whatever the cost of the tablets is on top of that, so though i may be better off sourcing them over there is it's possible.

    many thanks

    #1 Posted: 23/6/2008 - 19:56

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  • SBE

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    You can get Doxycycline but not Malarone in Bangkok. No need for a script. Highly likely there's no need for the antimalarials anyway. Most tourists don't use them and I've yet to meet an expat who takes them. Dengue is far more of a risk than Malaria in Thailand and there is no prophylaxis for that apart from insect repellents. Use DEET based repellents (cheap and widely available in Thailand)

    #2 Posted: 23/6/2008 - 22:25

  • somtam2000

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    #3 Posted: 24/6/2008 - 06:11

  • cj5892

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    I don't need the tablets for thailand but we are planning to spend some time in vietnam and cambodia so wanted to get them for going there. Will source some doxycycline in Bangkok then, thanks :)

    #4 Posted: 25/6/2008 - 15:21

  • SBE

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    According to that link Somtam posted there isn't much risk in the major tourist areas in Vietnam either and although it says there's a malaria risk in Cambodia, a long time expat I know living in Siem Reap didn't seem unduly concerned about it. He thought Dengue was far more of a risk there too...maybe because he's had Dengue Fever but never Malaria. Taking measure to avoid getting bitten is the only prophylaxis for Dengue and unlike Malaria there's no specific cure for it. Up to you but I'd concentrate more on repellents than antimalarials if I were you.

    If you do decide you'd prefer to take doxy then make sure you take it exactly as recommended. Many people take it erratically or stop taking it too soon. (You need to continue taking it for 2-4 weeks after returning home). In other words they might as well not have bothered. Also if you're a woman on the pill remember you'll need to use some other form of contraception while taking doxycycline.

    #5 Posted: 25/6/2008 - 17:26

  • fivesilver

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    Checked prices for doxycycline in the Silom Complex today. Lab Pharmacy (downstairs) has Doxycom at 30 baht for 10 capsules.
    By comparison, Watsons has the same at 42 baht for 10. Boots was asking 90 baht for 10 of its generic tablets, and 400 baht for 20 Vibramycin.

    #6 Posted: 1/5/2009 - 19:18

  • BruceMoon

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    cj5892 (and others)

    The use of doxycycline is to be resisted.

    Studies have shown that doxycycline is not a preventative of malaria. Rather, it merely minimises risk when properly taken.

    Pharmacologicists (chemists) advocate the use of doxydoxycycline not because its good. The motive is that the vendor gets a nice profit margin.

    WORSE is that there are a host of horrible side effects from the use of doxydoxycycline.

    If you are quite happy to fill your body with chemicals just in case, nothing anybody says will stop you.

    The more responsible approach to malarial risk is to take one course of malarone (or similar) with you, and if you get symptoms, start taking the malarone and get yourself to a good hospital quickly.

    Remember, chemical companies do tests on the short term effects of their drugs to meet regulatory protocols.

    The protocols DO NOT obligate the chemical companies to assess the risk of their drugs in conjunction with other chemicals (as drugs or in foods) or as long term possible carcinogens.

    If you value your body don't play with chemicals just in case. Use only as a last resort.

    Cheers

    #7 Posted: 5/6/2009 - 18:20

  • smartlyndy

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    Hi Bruce

    We took Doxycycline when we were in Cambodia and Laos in 2007 and were planning to take them again on our next trip. Do you know what the horrible side effects are which you refer to? We took them last time on the advice of The Travel Doctor in Adelaide. I'd like to think they dont have any vested interests!

    Lyndall

    #8 Posted: 20/6/2009 - 12:35

  • BruceMoon

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    Lyndall

    Guess where the Travel Doctor gets its funding? You guessed it, the chemical companies.

    For side effects, go see:

    http://antibiotics.emedtv.com/doxycycline/doxycycline-side-effects.html

    But, as with most drugs, the side effects reflect patient experience in the short term (Ie. immediate reactions).

    Most prophalactic drugs alter the body in some way. What is rarely studied is what happens to the body from long term drug usage. For example, Australian military in Vietnam were given anti-malarial prophalactic drugs. The resultant cancers from the long term use of those prophalactics are now recognised by DVA as a 'cause-effect' condition for a lifetime pension.

    IMHO drugs are a great product to treat a condition. I will never take drugs merely to prevent some condition. There are always other less harmful methods.

    Cheers

    #9 Posted: 20/6/2009 - 12:55

  • MADMAC

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    "IMHO drugs are a great product to treat a condition. I will never take drugs merely to prevent some condition. There are always other less harmful methods."

    I don't agree with this in areas where maleria risk is high. I used to live in an area of Africa with a very high rate of malaria infection and I used Meflequine daily - as we all did - we were ordered to. None of us got Malaria. The locals were racked with it.

    Having said that, if you have to balance risk versus gain. If the risk is low, then it's just not worth it.

    Doxy can, and in some of my friends has, caused hallucinations when sleeping and depression while awake. I know one guy I served with in Djibouti who had to stop taking it because it was really bringing him down. This was a case where the negative effect wasn't worth the mitigated risk.

    #10 Posted: 20/6/2009 - 13:37

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  • BruceMoon

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    MADMAC

    I suggest we are talking about SE Asia, not Africa.

    I've commented on the 'personal'. There is also the social on this topic.

    How many drugs have become useless because the vector has become resistant. So, unless NECESSARY we need to use caution and use alternate methods.

    Using a drug 'just in case' contributes to resistance.

    Cheers

    #11 Posted: 21/6/2009 - 10:18

  • MADMAC

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    Bruce
    I would say if you were going to Loei you should use a prophylactic.

    As for drug resistance - that's the name of the game. It's an ongoing war, new drug, drug resistance, new drug...

    #12 Posted: 21/6/2009 - 14:52

  • SBE

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    Doesn't the development of drug resistance have a lot to do with sub- therapeutic doses of anti-malarials being used as prophylaxis? (Chloroquine being a prime example)

    I never did understand why there is so little (apparent) resistance to doxycycline. Tourists take it sporadically, stop/start/don't finish courses yet hardly any resistance according to official sources like CDC and WHO.

    I'm not even sure there's much big pharma profit involved. It's easy to get a very cheap generic version in SEA and it's WAY cheaper than Malarone.

    It's no longer much use treating STDs in SE Asia because of resistance so how come it still (apparently) works to prevent you developing malaria?

    Strange.

    #13 Posted: 27/6/2009 - 22:56

  • SBE

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    PS Meflequine= mefloquine? (Lariam)? There's widepread resistance to that now, particularly in SE Asia, probably something to do with its long half life and its use as a prophylactic. Sub therapeutic doses yet again. Same same story as chloroquine except that mefloquine has nastier side-effects.

    Didn't anyone have side effects from taking Lariam in Africa Madmac? Those side effects you describe for doxy sound like the classic side effects of Lariam to me!

    I'm with Bruce on this one. TREATING malaria if/when it happens is the way to go, particularly in SE Asia where your risk of contracting malaria is relatively low. Using drugs as prophylaxis leads to fewer and fewer treatment options due to resistance and SE Asia already has the worst anti-malarial drug resistance problem in the world.

    #14 Posted: 27/6/2009 - 23:19

  • BruceMoon

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    SBE

    My understanding is that drug resistance depends more on the vector regime (the structure by which a pathogen lives) than useage (though useage plays an important role).

    Drug resistance occurs in several classes of pathogens:
    * bacteria (antibiotic resistance)
    * endoparasites ( antibacteriostatic resistance)
    * viruses (resistance to antivirals)

    Malaria is an endoparasite. This means, the pathogen lives in a host and is transmitted.

    While some classes of pathogen are targeted by drugs that are more effective than other pathogen/drug relationships, in clinical settings all drugs are effective.

    However, the issue of resistance is not the relative effectiveness of the drug, rather, the capacity of the pathogen to be re-enlivened in a mutated form in the host.

    The current swine influenza virus is a minor mutation of an earlier form. In very simple terms, the earlier form mutated and was 're-infected' into the host has adapted within the host to now produce a slightly different form that has infected the human population. The vector regime here is considered tardy (the infection/reinfection relationship is more accidental and hence the mutability transmission is considered slow [last major outbreak was 1967])

    In the case of malaria, the vector regime mutability transmission capacity is much faster. Both mosquito's and humans interact, are both widespread and the host has a far greater access to infect/re-infect.

    Obviously the malarial parasite may become tolerant to drugs should the drug useage regime not be affected correctly, and these 'tolerant' parasites are taken up by a host to be transmitted the sub-therapeutic dose issue.

    But, the far larger problem are the malarial parasites within a human who is taking a prophylactic drug which develop partial resistance. These parasites will generally mutate within the body and eventually succumb to the drug. However, where the mutated parasite is transferred to the mosquito, this new 'strain' will thus be transmitted to a variety of other hosts the advancement of resistance issue.

    There are two general approaches to preventing the spread of resistance: preventing malaria infections and, preventing the transmission of resistant parasites.

    Some first world nations (especially the US) advance the issue of chemoprophylactis (taking prophylactic drugs) primarily to minimise the outbreak of malaria in their nation caused by malaria carrying travellers. This policy has been widely advanced by drug companies, and hence readily adopted in the medical field.

    The ethical issue that has NOT been considered is whether prophylactic use in humans is harmful: (IT IS). It appears the economic cost of malaria as a public health issue is more important than the personal cost to travellers.

    The drug industry (apparently) advocate a position that new and enhanced anti-malarial drugs can be developed. For the drug industry, the REAL AND PRESENT DANGER of resistance is not regarded as a sufficient precaution to chemoprophylactis.

    (un)Cheers

    #15 Posted: 28/6/2009 - 08:02

  • MADMAC

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    "Didn't anyone have side effects from taking Lariam in Africa Madmac? Those side effects you describe for doxy sound like the classic side effects of Lariam to me!"

    We weren't using lariam SBE. We had Doxy and Mefloquine. I never heard anyone comment on side effects from mef, at least none they noticed. I used it for two years.

    #16 Posted: 28/6/2009 - 13:10

  • SBE

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    Mefloquine = Lariam Madmac!

    http://en.wikipedia.org/wiki/Mefloquine

    #17 Posted: 28/6/2009 - 14:09

  • SBE

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    PS It's a bit off topic but try as I might I still don't understand this bit of your post Bruce!

    “The current swine influenza virus is a minor mutation of an earlier form. In very simple terms, the earlier form mutated and was 're-infected' into the host has adapted within the host to now produce a slightly different form that has infected the human population. The vector regime here is considered tardy (the infection/reinfection relationship is more accidental and hence the mutability transmission is considered slow [last major outbreak was 1967]”

    Can you elaborate a bit?

    The NEJM says that the first human infection with triple-reassortant swine influenza A (H1) virus reported to the CDC occurred in December 2005.
    http://content.nejm.org/cgi/content/full/NEJMoa0903812

    … so what was that major outbreak in 1967 you referred to??

    #18 Posted: 29/6/2009 - 06:11

  • BruceMoon

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    SBE

    The first para of the NEJM article explains in medical terms the substantive issues relating to the point I was making. My point was about speed of mutation (not swine flu as such).

    As the NEJM alludes to, swine influenza has been around for some time, as has avian and human varieties. In the case of swine flu, there are reports of its existence from well before WW2, but no-one had the technology then to confirm.

    As the NEJM article describes, the current swine flu virus is a mutated variant that includes virii markers from avian and human influenza virii.

    As the article states "Between the 1930s and the 1990s, the most commonly circulating swine influenza virus among pigs — classic swine influenza A (H1N1) — underwent little change. However, by the late 1990s, multiple strains and subtypes (H1N1, H3N2, and H1N2) of triple-reassortant swine influenza A (H1) viruses — whose genomes included combinations of avian, human, and swine influenza virus gene segments — had emerged and became predominant among North American pig herds"

    So, somehow, the virus from the host (pigs) transferred to another animal species (maybe humans), some of whom may have also had the avian flu virus, and (here, theoretically) the mutated virus then infected the original host species (pigs). etc, etc, etc..

    The point I was making by referring to swine flu was about the relative speed by which a virus mutates via vector exposure. And, that the malarial parasite has an easier (and hence faster) pathway for genetic mutation.

    Hope this assists.

    Cheers

    #19 Posted: 29/6/2009 - 07:02

  • SBE

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    Yes but although mosquitoes interact with humans more than pigs do, flu strains mutate very fast....isn't that why they bring out new flu vaccines (mostly based on guesswork) every year?

    Intensive pig farms can't keep up with all the mutations in their herds... they even make their own customized vaccines. In fact I've been wondering if unsupervised vaccine use by Smithfields in Mexico didn't have something to do with the emergence of this new strain of swine flu.

    Between 2005 and February of this year there were only 11 recorded cases of humans catching swine flu. Now we've got a strain that is not only transmissible across species but also highly infectious between humans. That's what you call a "minor" mutation Bruce?

    When the WHO upped the alert level to a 6 that meant drug companies got billions of dollars in funding to make vaccines. Will these vaccines actually protect anyone from swine flu? No one has any real idea what the virus will be like by the autumn. Back in May, leading virologist Guan Yi said the new strain was "very instable". Margaret Chan said recently that it was "pretty stable". A few days ago German authorities say it's mutating already.

    I'm experiencing a bit of cognitive dissonance about just how likely a 2nd killer wave this autumn is, but it's obviously a highly contagious virus right now, even more so than seasonal flu maybe. The chances of seasonal flu and swine flu meeting up in the same person and producing a new mutant strain are getting less remote by the minute. And in Asia and Egypt there's also a bit of H5N1 about... if that picks up whatever gene mutation it was that suddenly made swine flu very contagious amongst humans then we are in big trouble.

    I'm also very suspicious about the effectiveness of anti-virals against this strain. Tamiflu is about 100% useless against the current seasonal H1N1 flu. The WHO/CDC say it works in vitro but I haven't seen much in vivo evidence that it does. At first the Brits gave it to every swine flu case and all their contacts...look at the UK case rate now, worst in Europe, Tamiflu didn't help much did it?

    Tamiflu is a very expensive drug and AT BEST it slightly shortens the length of time you are ill by a few hours. It almost always gets administered too late to work anyway because people don't get their test results within 48 hours of developing symptoms.

    There's isn't much evidence that it actually works to reduce mortality from H5N1 either.

    http://www.cdc.gov/EID/content/15/1/19.htm

    H5N1 resistance to Tamiflu in Egypt as well.

    http://www.emro.who.int/csr/media/pdf/ai_press_22_01_07.pdf


    Just before this swine flu outbreak was announced to the world, they were wondering what to do with all the huge stockpiles of useless Tamiflu.

    http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=widespread-tamiflu-resistance-spark-2009-03-02

    Coincidence?

    Maybe I'm too cynical but the health of big pharma shareholders seems to have a lot more to do with WHO/CDC drug recommendations than public health does.

    #20 Posted: 29/6/2009 - 17:49

  • SBE

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    Sorry I wandered a bit off topic there. Back to malaria:

    Cinchona bark contains several anti-malarial substances that work in synergy and there is no resistance to teas made with cinchona bark, just the various form of one alkaloid (quinine) that pharamceutical companies use to make patentable drugs.

    There has been no resistance to whole leaf artemisia annua teas for 2000 years, but resistance is now occurring to semi-synthetic derivatives of one molecule (artemisinin) that drug companies extract from the plant.

    Why did they chose to combine Lariam with Artesunate in Cambodia? Makes NO sense to me to try and prevent resistance by combining an artemisinin derivative with a drug that doesn't work. I read somewhere that there's a high cross resistance risk between lumefantrine (used in Coartem) and mefloquine too.

    There are a few other promising plants about that work to cure malaria but you won’t hear about them till the drug companies can make money out patented derivatives of the active ingredients. I bet they try and make a combination therapy with Lariam for this one too.

    http://horizon.documentation.ird.fr/exl-doc/vcc/2006/11/010037653.pdf

    #21 Posted: 29/6/2009 - 17:52

  • BruceMoon

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    SBE

    While your comments on influenza are not on target with the substantive matter, nevertheless, they provide an interesting observation that can be related to the broader topic of travelling: which is why we are here on Travelfish.

    Let me ramble to get to my point.

    It is patently obvious to me that the primary key component in the 'process' of pathogen mutation within the west is the use of antibiotics in herd management. No farmer wants to spend big $$$'s on antibiotics and other exotic herd management inputs. So, they invoke a sub-therapeutic dose to save money. While herd immuno-resistance is diminished by the use of antibiotics, the propensity for pathogen mutation appears to then be enhanced because of both immuno-resistance and sub-therapeutic application.

    In Asia, the sheer bulk of avian excretement on the landscape is far greater than can be (organically) biodegraded. As a result, there must be a range of pathogens latently residing in the landscape. And, with very large herd numbers coupled to farmer ignorance (and minimal cash to access remedial outcomes), the propensity for pathogen mutation is high.

    I have no academic background to know, but I always wonder whether mass tourism (travelling?) is not also a key component in the increasingly rapid mutability of pathogens.

    Some time back, when a particularly nasty strain of avian flu was circulating the globe, we heard the transmission of same was because of (infected) migratory birds.

    We all know that pigs can't fly, so this appears to mean the migratory bird theory is inaccurate. As we saw with travellers turning up at airports with suspected swine flu being 'locked down', it would appear public health officials accept that the traveller is a cause of spreading the disease (not migratory birds!!).

    But, couldn't we also suspect that travellers with a 'dose' of a mutated strain of a disease may be responsible for the transmission of same to areas where the mutability process may be assisted by a lack of hygene, or similar.

    If so, it adds another factor to the impact of tourism on/in non-affluant parts of the world.

    - - - -

    On the topic of herbal remedies, ecologists use this principle to argue for the retention and preservation of intact ecosystems. They submit that 'pharmacological science' has not fully explored the potential remedies lying within the natural biotic world.

    While in Taman Negara (Malaysia) a couple of years ago, I came across a tribe of Orang Asli. I initially marvelled at the fact of the 21st century traveller coming into contact with hunter-gatherers living a centuries old tradition. I also marvelled at the fact that here I was being attacked by leeches and mosquito's with no apparent protection from the application of DEET, while they used select vegetation as their protection with obvious great success.

    Clearly, modern chemical derivations are no match for mother nature.

    As an aside, here in Australia we have a coastal biting insect called a midge, and most who come into contact get painful then very itchy welts (as a reaction). I found that neat ti-tree oil - from a melalueca tree - negates any reaction after about 2 minutes. No chemical company product can do this.

    As a result, there are farmers growing melalueca trees to harvest for ti-tree oil.

    Maybe instead of growing corn as a cash crop in (previously) opium growing areas on north SE Asia, we could get hilltribes peoples to grow products that when harvested and distilled/processed, could provide protection against malaria and other 'problem' issues.

    Cheers

    #22 Posted: 30/6/2009 - 06:13

  • SBE

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    "While your comments on influenza are not on target with the substantive matter"


    I think we are in general agreement about most things Bruce and I don't claim to be an expert on any of this stuff, but I find that statement just a tad patronizing!

    Here again is what you said in that previous post that I found rather hard to understand:

    "The current swine influenza virus is a minor mutation of an earlier form. In very simple terms, the earlier form mutated and was 're-infected' into the host has adapted within the host to now produce a slightly different form that has infected the human population. The vector regime here is considered tardy (the infection/reinfection relationship is more accidental and hence the mutability transmission is considered slow [last major outbreak was 1967]"


    And here are are the opening words of the official statement by WHO Director-General Dr Margaret Chan when she raised the pandemic alert level to a 6 :

    "In late April, WHO announced the emergence of a novel influenza A virus. This particular H1N1 strain has not circulated previously in humans. The virus is entirely new."

    You say it's a minor mutation and that a major outbreak occurred in 1967. Margaret Chan says it's entirely new and has never previously circulated in humans and you still haven't clarified what you referring to when you said the "last major outbreak" was in 1967. I can't find any reference to a major flu outbreak that year. Hong Kong flu happened in 1968-69. The Swine flu fiasco was in 1976.

    Hence my difficulty in immediately grasping your "substantive point"!

    I'm guessing what you meant was that this new strain is similar to one that has been circulating widely in US swine herds since 1998 but I'm not sure. AFAIK it's never been seen in humans before and it wasn't around in 1967 either.

    You also seem to be saying that the malaria parasites mutate faster than flu virii.

    Are you saying that RNA viruses such as influenza mutate more slowly than malaria falciparum strains?? I keep seeing people saying how difficult it is to keep up with new flu strains because they mutate constantly. How come new antimalarials usually work pretty effectively for a few years before resistance sets in?

    And although I totally agree with your point about the massive use of antibiotics leading to resistance, I don't see what it has to do with flu which is a viral disease. I mentioned the overuse vaccinations by swine producers as being a possible reason for the emergence of this new strain because although vaccinations can stop the animals developing symptoms, they apparently don't stop them shedding viral particles.

    There's a lot of chicken shit in Asia for sure but what about the sheer volume of fecal waste from intensive factory farms like Smithfields? Check the photos on here out.

    http://litbrit.blogspot.com/2009_04_01_archive.html

    What about flies feeding on fecal waste as a primary vector in Veracruz? This new flu seems to have a lot of gastro symptoms as well as classic flu flu symptoms. Maybe it isn't just spread by coughs and sneezes?

    #23 Posted: 30/6/2009 - 19:34

  • BruceMoon

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    SBE

    Sorry if my words came across as patronising.

    As for the remainder, it appears I have failed in my intentions to use swine flu as a means to show that some pathogen mutations occur faster than others (in this case malaria). Oh, well...

    Cheers

    #24 Posted: 1/7/2009 - 08:05

  • kiwibc

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    Posted from within Vietnam.

    I've used doxy on various continents round the world and never had any issues, and I know, and have traveled with, a hell of a lot of others and they've been ok too (not even extra sensitive skin). If you didn't use any drugs because of 'potential' side effects you wouldn't use anything! Look at any drug (prescription or not) and there is nearly always a host of 'potential' effects. However, I have known (personally) people to have major problems with Larim/Melq on the psychiatric front though so I'd give that one a wide berth (or if you do take it don't drink booze on the day/night you take it!). Wikipedia reckons 25% and I reckon that would be about right given I know several people who have tried it and more than a couple had problems (one permanent!)

    In saying that I'm on a 4 month trip through asia and as we are more or less sticking to the tourist trail (i.e. low risk malaria)we are taking it. I'd have to strongly disagree about the whole profit margin thing and drug companies and vendors pushing it for a couple of reasons. You can get doxy as a generic drug now (it has been around since Vietnam war) so there ain't much profit from the drug companies perspective as any drug company could make it, also I was going to take it round asia (as a just in case) and the travel doctor said no not to worry (even I said I'd prefer to take it!) it's a waste of time as it just minimises the risk (as like any anti-malarial) and the tourist trail is a low risk area anyway; which puts a slight hole in the 'travel doctors just try and shove it down your throat' theory.

    Being a broad based antibiotic there are pros and cons. A pro is it protects you from a host of other nasties out there. The con is being a broad spectrum antibiotic it ain't to good for your immune system if you take it to long as it'll happily wipe out good and bad bugs and your body can get dependent on it for protection. And then there is also the point that too much (mis)use breeds immunity which ain't good for the locals as has been pointed out.

    In summary I'd just talk to you're travel doctor as they have very up to date electronic malaria risk maps which were very detailed and interesting and I haven't been able to find anything like them on the net for free.

    #25 Posted: 1/7/2009 - 13:29

  • BruceMoon

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    Ahhhhhh!!!!!!

    If you believe the travel doctor is an unbiased source of information, you'll probably also believe in tooth fairies!

    #26 Posted: 1/7/2009 - 13:55

  • kiwibc

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    Posted from within Vietnam.

    Firstly, for the record I'd like to correct a mistake I made in my last post. We aren't taking anti-malarials in asia. My last post said we are I missed off the 'n't' :-). Re. on my last post I was talking from personal experience here and research I have done, I didn't say that there is NEVER any baised opinions from Travel Doctors. I said from PERSONAL experience they have not tried to shove drugs down my throat when I don't need them and I've traveled, worked and lived in over 40 countries. As mentioned in my previous post this puts a slight hole in the implication that travel doctors are purely agents of drug companies which has been insinuated in various posts.

    I will always do my own research before going to the Doctors and weigh up the risks. Sometimes they have recommended things I haven't agreed with however generally I'd like to think they are erring on the side of caution (and in some litegeous countries covering their asses) rather than seeing you as a walking commission generator. I was recommended Doxy in the past (which was my preference to begin with out of the three); no doubt they would have made a truck load more from Malarone which costs the same per day as doxy does for a week in NZ!

    One other point on Malaria. You are right that if you get it you would take malarone and get to a hospital but that's assuming you recognize the symptoms. YOU may, someone else may not. In Africa I met a few people who had in several times. The first time was the diciest as they almost left it to late. After the first time they recognized the symptoms a lot quicker and got to treatment earlier. This has to be factored into the advice given as it seems from other posts this has not been mentioned leaving people with the impression they'll know it's malaria pop a pill and wander off to the doctor for treatment.

    #27 Posted: 1/7/2009 - 14:58

  • SBE

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    First off I'd like to know how you manage to do bold print and italics Bruce!


    Then I'd like to clarify something kiwibc said. Are you, or are you not taking anti-malarials during your trip and if so which ones?

    I too have lived in Africa and the only place I know in SE Asia which has a malaria risk comparable to that of central and west Africa is central Sulawesi. If you are going there then I'd DEFINITELY make sure you have a curative dose of Malarone with you. Forget doxy, even if there is no resistance to it, it doesn't work fast enough to cure you when you have malarial symptoms.

    Also there's another problem that rarely gets mentioned on travel forums or in tropical health clinics. Doxycycline is a tetracycline and according to the drug interaction warnings in the detailed prescription guidelines:

    "Concomitant treatment with tetracycline has been associated with approximately a 40% reduction in plasma concentrations of atovaquone."

    http://www.rxlist.com/malarone-drug.htm

    So whatever you do, don't take doxy and Malarone together.

    (Pity I can't do bold print for that bit).

    Also, Malarone and artemisinin derivatives are designed to treat falciparum malaria (the deadliest kind). They are not recommended for treating vivax.

    I don't know what kind of malaria doxy is supposed to prevent, maybe both? What I do know is that you can develop malaria once you stop taking the anti-malarial prophylaxis.

    Years ago my son developed vivax about a month after we got back to France from the Ivory Coast and I had a heck of a job trying to get my GP to do a blood test. He had never actually SEEN a case of malaria and was convinced it was flu.

    #28 Posted: 1/7/2009 - 21:58

  • kiwibc

    Joined Travelfish
    21st June, 2009
    Posts: 18

    Posted from within Vietnam.

    Hi SBE. Sorry for confusion; we are NOT taking anti-malarials in asia. You are spot on on the risk of malaria africa vs asia; my point in the african example was around people who haven't had malaria before (including me) identifying they have something serious enough to get to a hospital where ever they are round the world. I had a bad fever/flu/nausea in south america and rode it out for a couple of days without seeing a doctor and in the back of my mind was how would I know if this is the beginning of malaria and when is it time to see a doctor?

    You're right on doxy and malarone too. I've heard and seen the evidence that malarone is a lot more effective than doxy. However in NZ its $9 a tablet per day (last time I checked) where as doxy is around $4 a week (i.e. less than a 10th of the cost) so on the longer 3-4 month trips for two people if we do have to take something (and we are not going to an area that is doxy resistant) then I've taken doxy. As you say it's no where near 100% effective (as opposed to Malarone which I heard was a few years ago around the 98% mark?) but it's always a case of weighing up the %'s ;-). If I was on a short trip and I needed anti-malarials then malarone would be my first choice. On the asian trip it's not worth it - I really don't like taking any drugs esp antibiotics unless I need to.

    Good point on the mixing of drugs; I wonder how long after stopping doxy you can take malarone? The next day?

    #29 Posted: 2/7/2009 - 08:10

  • BruceMoon

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    SBE

    When a number of posts is reached by a member, Travelfish allows that member to use (limited) BB code. I don't know what the 'number' is, Somtam might advise.

    If when you are logged in, you go to (say) the Thailand forum page, at the bottom of the 'new post' are, you'll see (under 'check this box...) a set of words advising whether BB code is enabled. I'd imagine it is for you.

    To see how BB code is used, go to:

    http://en.wikipedia.org/wiki/BBCode

    I've only found italics and bold to work on Travelfish.

    Just in case, I'll try others here...

    underline

    Large Text

    Red Text

    [:-)]

    If these don't work, you'll see examples of how to encode BB to apply to text. If they do work, you'll only see the outcome.

    Cheers

    #30 Posted: 2/7/2009 - 09:35

  • BruceMoon

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    WOWEEEE!!!

    I've just discovered that I've been under a misapprehension that BB code on Travelfish was limited to italics and bold

    Cheers

    #31 Posted: 2/7/2009 - 09:38

  • SBE

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    Uh oh, what have I done. I bet Somtam bans BB code forever before I even get a chance to experiment now! ;-)

    According to wikipedia doxy has a half life of 18-22 hours so there will be low levels will be in your blood for a few days after you stop taking it.

    I agree about the difficulty in diagnosing malaria. My partner was very ill with undiagnosed falciparum malaria for well over six months in the Congo. The doctors there knew perfectly well what malaria symptoms look like but their unshakable faith in their own lab expertise and chloroquine made them believe it couldn't be malaria in spite of textbook symptoms.

    Everyone in my family has had malaria. I know better than most people what vivax and falciparum symptoms look like, yet when a friend came down with a fever in the Togians on last my trip I still wasn't 100% sure what it was. It looked like it could be falciparum to me but we'd previously been told there was only vivax in that area by a local resort owner in Ampana. Also one of the main symptoms was terrible bone aches so it could have also been dengue. Malarone is no use against Dengue and is not recommended for treating vivax, plus there can be quite bad side effects as you have to take 4 tablets a day in a single dose and she was already feeling terrible.

    It's not easy to know what to do when you can't get to a hospital for a blood test.

    Turned out that it was falciparum BTW.

    #32 Posted: 2/7/2009 - 13:09

  • BruceMoon

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    SBE

    The idea of half life in drug use isn't as simple as chemicals in the (outdoor) environment. I refer to a Uni Nottingham post:

    The duration of action of a drug is known as its half life. This is the period of time required for the concentration or amount of drug in the body to be reduced by one-half. We usually consider the half life of a drug in relation to the amount of the drug in plasma. A drug’s plasma half-life depends on how quickly the drug is eliminated from the plasma. A drug molecule that leaves plasma may have any of several fates. It can be eliminated from the body, or it can be translocated to another body fluid compartment such as the intracellular fluid or it can be destroyed in the blood. The removal of a drug from the plasma is known as clearance and the distribution of the drug in the various body tissues is known as the volume of distribution. Both of these pharmacokinetic parameters are important in determining the half life of a drug.

    So, depending on the drug pathway, if the drug were lipophyllic (for example), the duration of impact may be in the order of days.

    Hope this helps

    Cheers

    #33 Posted: 2/7/2009 - 14:42

  • kiwibc

    Joined Travelfish
    21st June, 2009
    Posts: 18

    Posted from within Vietnam.

    Cheers guys, interesting stuff. If I get malaria hope I get doctor who is switched on!

    #34 Posted: 2/7/2009 - 17:17

  • BruceMoon

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    kiwibc

    As has been suggested, it is possible that one gets ill but the symptoms don't immediately suggest malaria.

    I've had the dubious honour of having had malaria. At the time, I was just 'crook' (to use an Australian slang).

    I don't take prophylactic drugs, and travel with malarone in case.

    But, I can assure you, if I got to feel like any sort of fever was beginning in my body, I will go to a doctor and tell him/her I want a malaria check. To me, the cost of such a check isn't ever going to be a problem.

    Cheers

    #35 Posted: 6/7/2009 - 09:27

  • SBE

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    That's assuming you can GET to a doctor quickly Bruce. If you can then you don't really need anti-malarials at all.

    What about if there are no doctors and no pharmacy?

    The nearest place you can get a blood test and treatment if you're on the Togians for example is at the very basic hospital in Ampana which is 4-6 hours away on public ferries. These ferries run 4 days a week only ...if they are all running, which they weren't when I was there.

    It's quite an ordeal travelling on those clapped out wooden boats at the best of times and peak malaria season also happens to be at the time of year when the seas are roughest. The locals can't afford to go to hospital and get treatment anyway.

    I discussed all this with a local community leader on a previous visit. His solution was to ask tourists to donate any spare anti-malarials they had. He was grateful for anything they could give ... mostly doxy and Lariam because Malarone is so expensive. He rarely enough for a proper curative dose, just the odd pill and he had nothing to give young children or babies. Not a very satisfactory arrangement.

    So this year I brought some specially bred artemesia annua seeds (high artemisinin yeild) and we tried to plant them so that they'd have access to a free and effective cure with low toxicity right there on the islands.

    Unfortunately my wee project failed because of malaria. My friend came down with it a few days later and I had to get her to hospital so I wasn't around to explain the tricky bit...seed germination and transplantation of the seedlings. When I returned in March to see how things were getting on and get a leaf sample for the lab to test, the guy told me that the plants hadn't survived... washed out by torrential rains during the monsoon.

    I just uploaded a few pics on my flickr site showing where we sowed the seeds if you're interested.

    http://www.flickr.com/photos/8675349@N06/3693614885/

    http://www.flickr.com/photos/8675349@N06/3693580615/

    http://www.flickr.com/photos/8675349@N06/3693577931/

    http://www.flickr.com/photos/8675349@N06/3694380050/

    #36 Posted: 6/7/2009 - 22:20

  • BruceMoon

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    SBE

    Why is it that, when we are discussing the use of insect repellant's in SE Asia, contributors appear eager to cite places way out the back of beyond?

    I was commenting on SE Asia - like, on the tourist track?

    Not, some far flung island off the tip of Sulawesi.

    Mmmmm!!!

    - - - -

    On the other aspect (the plantings), why did you focus on artemesia annua?

    Elsewhere on Travelfish you cited the use of Neem, and linked to PubMed lists:

    http://www.travelfish.org/board/post/travelhealth/3962_deet-or-picaridn-

    The abstracts listed suggested that the efficacy of Neem oil is now sufficiently well studied to support an hypothesis that Neem oil is a useful insect repellent in tropical areas.

    But, perhaps the most compelling point of this is that the Neem tree (]i]Azadirachta indica is a tropical plant (from the Indian sub-continent) and would appear well suited to Indonesia.

    Vegetable oil processing is a simple process, and so could readily be mastered in low skilled communities.

    Given this, you may like to consider further. Go see:

    http://en.wikipedia.org/wiki/Neem_oil

    http://en.wikipedia.org/wiki/Insect_repellent

    http://www.discoverneem.com/natural-mosquito-repellent.html

    Cheers

    #37 Posted: 7/7/2009 - 06:40

  • SBE

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    As I said before you don't really need anti malarials if you can get to a hospital quickly. A doctor working in a Burmese refugee camp where there was quite a lot of malaria told me that none of the medical staff there took prophylaxis. If they caught malaria they just went to a hospital and got a blood test and treated appropriately. Falciparum can be cured in 3 days with an artemisinin based treatment.

    The reason I took artemisia annua was because a packet of seeds is very easy to transport and (if the plants grow) you can have a usable treatment within a few months. It has been done in Africa already but never on equatorial islands like the Togians. That's why I went back in March to get a leaf sample. The research center I got the seeds from wanted to test the artemisinin content of plants grown there.

    http://www.icei.it/pdf/Report_Artemisia_ICEI.pdf

    I've already looked into Neem. If I remember right the problem with that was that only fresh seeds germinate. I had no source of fresh seeds and even if I had I couldn't be in Indonesia at the right time to plant them. Besides even fast growing trees like Neem take longer to grow than an annual herbaceous plant!

    The other possibility is cinchona (quinine) trees as you can make teas from the bark of those which are also very effective. There may be some in the jungle there already but it's not very easy to look for them!

    #38 Posted: 7/7/2009 - 08:05

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