long term prophylactic use

Can any one help me?

I am going to do a year long project in South Africa and i am trying to
decide what to do about anti malarials, all the reading says take them, wear
long sleves etc. However, i have come accross people and articles that say
long term exposure to these drugs can cause liver and kidney damage, if any
one can offer me any guidence on this i would be very appreciative.

Mike Collins

Where will you be in South Africa?

Regards,
Marc

On Tue, 10 Oct 2006 11:25:48 GMT, "mikeyc" u27709@uwe wrote:

Can any one help me?

I am going to do a year long project in South Africa and i am trying to
decide what to do about anti malarials, all the reading says take them, wear
long sleves etc. However, i have come accross people and articles that say
long term exposure to these drugs can cause liver and kidney damage, if any
one can offer me any guidence on this i would be very appreciative.

Mike Collins

On Tue, 10 Oct 2006 11:25:48 GMT, mikeyc wrote:

I am going to do a year long project in South Africa and i am trying to
decide what to do about anti malarials, all the reading says take them, wear
long sleves etc. However, i have come accross people and articles that say
long term exposure to these drugs can cause liver and kidney damage, if any
one can offer me any guidence on this i would be very appreciative.

Mike,

first of all, I'm not a professional in that area, so everything
I write may be wrong. You may have to go to the source. Why not
write to the manufacturer of the prophylactic drug of your
choice and ask about long term exposure, if it's not already
written in the instructions for use? At least ask a specialist
on tropical diseases.

That said, I think you should not take prophylactics for months
or even years. I'm in a similar situation, and when I'm in an
area that has a malaria risk, I do the following.

1. I always carry a treatment dose with me and take it when I
get an inexplicable fever that could be malaria.

2. I always sleep under a mosquito net, unless I'm very sure
that the room is free of mosquitos and that they can't get in.

3. I impregnate my mosquito net with suitable insect repellant
(which probably contains DEET).

4. I wear long trousers and long-sleeved shirts when I'm exposed
to mosquitos.

5. I spray the most vulnerable areas, the ankles, etc., with
insect repellant before I'm exposed to mosquitos.

The result for me has been that I never contracted malaria in
several years in east Africa and took a cure dose only once.
Even then it turned out that it was not malaria.

Hans-Georg

--
No mail, please.

I'd generally agree with Hans-Georg and his post. However, YOU are the
only person who knows YOURSELF and how well you are likely to adhere
to an anti-malaria regime.

If you are a very responsible person and WILL use repellants and nets
etc. then you needn't take prophylactic drugs. Just make ABSOLUTELY
sure that you follow anti-malaria precautions, and if you feel ill,
GET MEDICAL OPINION IMMEDIATELY. I'm not over-reacting here. Malaria
can kill in a matter of days. DON'T mess with this disease.

If you are not totally responsible, then there are drugs that are
reasonably well-tolerated for long periods. Doxycycline is a
broad-spectrum antibiotic that is an effective prophylaxis. It has
been used for many years as a long-term medication for acute acne with
very few side effects.

I must remind you that, even with prophylactic drugs, you will still
need to be dilligent and responsible about regularly taking the drugs.

Of course, it all depends on exactly where you'll be working in South
Africa, and what sort of work you'll be doing. Only a very small part
of the country has endemic malaria.

Regards,
Marc

On Tue, 10 Oct 2006 14:14:10 +0200, Hans-Georg Michna
wrote:


Mike,

first of all, I'm not a professional in that area, so everything
I write may be wrong. You may have to go to the source. Why not
write to the manufacturer of the prophylactic drug of your
choice and ask about long term exposure, if it's not already
written in the instructions for use? At least ask a specialist
on tropical diseases.

That said, I think you should not take prophylactics for months
or even years. I'm in a similar situation, and when I'm in an
area that has a malaria risk, I do the following.

1. I always carry a treatment dose with me and take it when I
get an inexplicable fever that could be malaria.

2. I always sleep under a mosquito net, unless I'm very sure
that the room is free of mosquitos and that they can't get in.

3. I impregnate my mosquito net with suitable insect repellant
(which probably contains DEET).

4. I wear long trousers and long-sleeved shirts when I'm exposed
to mosquitos.

5. I spray the most vulnerable areas, the ankles, etc., with
insect repellant before I'm exposed to mosquitos.

The result for me has been that I never contracted malaria in
several years in east Africa and took a cure dose only once.
Even then it turned out that it was not malaria.

Hans-Georg

Thank you both of you, some very helpful information.

I am going to be in Limpopo province near the town of Hoedspruit if you know
it. My understanding is that it is in an intermediate risk area.

I would consider myself responsible and obviously, i will need to do more
research, but perhaps not using medication is the solution. Thank you both
for your help.

Hans; you mentioned a treatment dose, am i correct in assuming that this is
just a normal course of anti malarials which you take if you feel any
potential symptoms.

Thank you both for your time

Mike Collins

On Tue, 10 Oct 2006 15:13:55 GMT, mikeyc wrote:

Hans; you mentioned a treatment dose, am i correct in assuming that this is
just a normal course of anti malarials which you take if you feel any
potential symptoms.

Mike,

there is no simple, general answer. Several prophylactic drugs
can also be taken as a cure, in a several times higher dose and
adhering to a special schedule. A totally fictitious example
would be:

Take 3 pills immediately. 2 hours later take another one. 6
hours later take yet another one, then take one per day for
three days.

I have just made this up. Real schedules are different. You have
to read the instructions.

Malarone and Lariam can be taken as a cure, for example. (I once
took the Lariam cure dose, and it was an unforgettable mental
horror trip. Malarone is not so bad.)

However, there are some medications that cannot be taken as a
cure (I believe doxycycline is among them) and some others that
can only be taken as a cure (perhaps artemisinine, but again I'm
not sure). Moreover, some drugs, like for example Malarone, cure
certain kinds of malaria, like malaria tropica (the killer
malaria), but not others, like malaria tertiana (the recurring
malaria that doesn't kill you quickly, but is harder to cure),
so if you take it, you should still visit a specialist hospital
within very few days.

My personal recommendation is Malarone, but that's also the most
expensive anti-malaria drug. However, when you only carry one
pack as a cure, the price is OK, particularly since it doesn't
expire before several years.

Hans-Georg

--
No mail, please.

Thank you Hans

I appreciate all your assistance on this matter

Mike

--
Message posted via TravelKB.com
http://www.travelkb.com/Uwe/Forums.aspx/africa/200610/1

Hi Mike,

I know Hoedspruit reasonably well. It is pretty much a seasonal
malaria area with a far lower chance of malaria in the winter months.

The VAST majority of malaria cases in the area are P. Falciparum
(Hans-Georg refers to it as "tropica") and indeed, this is the strain
that is deadly. Early intervention is critical after infection. I know
of far too many people who insist that they merely have 'flu for two
or three days, and then end up in intensive care for a few weeks. A
friend of a colleague has recently spend 6 weeks in intensive care,
and will be undergoing at least 5 months of rehabilitative therapy
after he contracted Falciparum, but neglected to seek treatment for a
week.

If you have easy access to a good hospital in the area, then I
wouldn't worry about carrying a cureative dose, but rather go off to
the doctor if you have any symptoms. All private hospitals in the area
have extensive knowledge of malaria, and they are well-equipped to
handle and treat it.

The female anopheles mosquito (the bitch that carries the parasite),
is usually active around dusk and dawn, so that's when you have to be
most carefull.

If you are carefull with repellants and impregnated nets, the chances
of contracting malaria is small, however not negligable.

Regards,
Marc

On Tue, 10 Oct 2006 15:13:55 GMT, "mikeyc" u27709@uwe wrote:

Thank you both of you, some very helpful information.

I am going to be in Limpopo province near the town of Hoedspruit if you know
it. My understanding is that it is in an intermediate risk area.

I would consider myself responsible and obviously, i will need to do more
research, but perhaps not using medication is the solution. Thank you both
for your help.

Hans; you mentioned a treatment dose, am i correct in assuming that this is
just a normal course of anti malarials which you take if you feel any
potential symptoms.

Thank you both for your time

Mike Collins

On Tue, 10 Oct 2006 11:25:48 GMT, "mikeyc" u27709@uwe wrote:

Can any one help me?

I am going to do a year long project in South Africa and i am trying to
decide what to do about anti malarials, all the reading says take them, wear
long sleves etc. However, i have come accross people and articles that say
long term exposure to these drugs can cause liver and kidney damage, if any
one can offer me any guidence on this i would be very appreciative.

Mike Collins


Doxycycline is certainly a good choice for long-term use. It's been
well tested over time, especially in long term use. It's cheap
(something the other anti-malarials aren't).

The disadavantages a can't be taken at the same time as milk
products, but since it's once a day, most people do OK with that.
some people get a photosensitivity
reaction with Doxy, make sure you use sunscreen when on Doxy.

Ultimately, prophylaxis is good, but not 100% effective. The best
prevention is not getting bit, use a good DEET repellant, wear long
sleeves and long pants, use a mosquito net with pyrithin impregnation.

and remember sp. anoph. only bites at night, so those long pants and
shirts are extra important at night.

Grant Kinsley MD

On Wed, 11 Oct 2006 17:10:00 GMT, grant kinsley
wrote:

SNIP SNIP SNIP
and remember sp. anoph. only bites at night, so those long pants and
shirts are extra important at night.

Grant Kinsley MD

I understand that the anopheles is mostly active only for a few hours
each side of dusk and dawn.

From my own experience, relying on long trousers and long sleeved
shirts is pointless in many areas due to the heat. There is absolutely
no way you'd be able to wear long sleeved shirts in most countries
during the summer months or in the hot rain season.

DEET is the way to go, but be careful of the stuff because it eats
certain plastics. The front cover of my mobile phone was completely
chewed away by the DEET on my ear :-) It also tastes revolting :-(

Marc