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#1
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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 |
#2
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long term prophylactic use
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 |
#3
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long term prophylactic use
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. |
#4
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long term prophylactic use
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 |
#5
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long term prophylactic use
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 |
#6
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long term prophylactic use
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. |
#7
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long term prophylactic use
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 |
#8
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long term prophylactic use
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 |
#9
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long term prophylactic use
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 |
#10
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long term prophylactic use
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 |
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