Tropical Travelers, Don’t Forget Malaria Pills

We are in the middle of the summer travel season, and many people are travelling to southern and tropical countries. Many of those areas have mosquitoes that can transmit malaria, a nasty parasite that can make people very sick. Malaria still kills about 1 million people a year worldwide — 85% of whom are children under 5. Taking certain medicines as prevention can dramatically reduce your risks of getting this very common tropical disease. The big problem is resistance to medicines, which varies by country — which is why travelers need to check out the CDC travel website, read their FAQ on their travelling country and find out which medicines (and vaccines) they need. You can also take a quick look at the malaria map below for Asia, which is updated at another CDC malaria website:

Malaria Map Asia 2010
Malaria Map Asia 2010

Which Medicine To Take?

Each malaria medicine has its pros and cons, especially with side effects and cost. There’s a recent literature review by the Cochrane Collaboration, the leading group on evidence-based reviews, which showed that some medicines, especially mefloquine, may not be as safe as others. Here’s their nice summary:

…Atovaquone-proguanil and doxycycline are the best tolerated regimens. Mefloquine has more adverse effects than other drugs, and these adverse effects are sometimes serious. However mefloquine may still be an appropriate choice for those travellers who have taken it previously, without any adverse events. Other factors should be considered by prescribers, in addition to tolerability: cost, ease of administration, possible drug-drug interactions, travel itinerary, and the additional protection that may be afforded by doxycycline against other infections, besides malaria.

My favorite malaria prevention medicine for patients is doxycycline, and I’m glad this latest review reinforces its safety profile over the others. It also is usually cheaper — although it must be taken daily, and for 28 days after return from vacation.

Don’t Forget To Do Some Research First

As I’ve mentioned before, travelers should first check a travel website like the US CDC Travel page, and read their country’s description for the latest recommendations on vaccines, medicines, disease outbreaks and security issues. It can provide you a lot of peace of mind.

Other pearls:

  • Don’t forget your mosquito spray! This is crucial, especially for children. Mosquitos spread a lot more diseases than just malaria.
  • Do your research at least a month earlier, as you may need special vaccines such as japanese encephalitis, rabies, or yellow fever
  • Don’t forget your travel kit, which should have medicines for diarrhea, fevers, allergies, skin rashes, etc…

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