Travel Reference
In-Depth Information
THE ANTIMALARIAL A TO D
» A - Awareness of the risk. No medication is totally effective, but protection of up
to 95% is achievable with most drugs, as long as other measures have been taken.
» B - Bites are to be avoided at all costs. Sleep in a screened room, use a mosquito
spray or coils, sleep under a permethrin-impregnated net at night. Cover up at night
with long trousers and long sleeves, preferably with permethrin-treated clothing. Ap-
ply appropriate repellent to all areas of exposed skin in the evenings.
» C - Chemical prevention (ie antimalarial drugs) is usually needed in malarial areas.
Expert advice is needed as resistance patterns can change, and new drugs are in de-
velopment. Not all antimalarial drugs are suitable for everyone. Most antimalarial
drugs need to be started at least a week in advance and continued for four weeks after
the last possible exposure to malaria.
» D - Diagnosis. If you have a fever or flulike illness within a year of travel to a mal-
arial area, malaria is a possibility, and immediate medical attention is necessary.
MEDICATION
Many travellers are under the impression that malaria is a mild illness, that treatment is al-
ways easy and successful, and that taking antimalarial drugs causes more illness through
side effects than actually getting malaria. In Africa, this is unfortunately not true. Side ef-
fects of the medication depend on the drug being taken. Doxycycline can cause heartburn,
indigestion and increased sensitivity to sunlight; mefloquine (Larium) can cause anxiety
attacks, insomnia and nightmares, and (rarely) severe psychiatric disorders; chloroquine
can cause nausea and hair loss; and atovaquone and proguanil hydrochloride (malarone)
can cause diarrhoea, abdominal pain and mouth ulcers.
These side effects are not universal, and can be minimised by taking medication cor-
rectly, eg with food. Also, some people should not take a particular antimalarial drug, eg
people with epilepsy should avoid mefloquine, and doxycycline should not be taken by
pregnant women or children younger than 12.
If you decide that you really do not wish to take antimalarial drugs, you must under-
stand the risks, and be obsessive about avoiding mosquito bites. Use nets and insect repel-
lent, and report any fever or flulike symptoms to a doctor as soon as possible. Some
people advocate homeopathic preparations against malaria, such as Demal200, but as yet
there's no conclusive evidence that this is effective, and many homeopaths don't recom-
mend their use.
