Which anti-malarial?

Of the four types of malaria parasite, the most deadly species, Plasmodium falciparum, accounts for 90 per cent of infections in sub-Saharan Africa. Your choice of anti-malarial – or whether to take one at all – could be the most important decision you make before travelling to a risk area.

It’s important to take the right type of anti-malarial for your circumstances. Certain drugs may be unsuitable because of side effects, while parasites where you’re travelling may have developed resistance to others. Your age, health, length of stay and budget are also considerations. Anti-malarials require a prescription, which means you’ll need to visit a travel clinic or doctor who should take these factors into account.

What are your choices?

Three anti-malarials are endorsed by South Africa’s Department of Health: Doxycycline, Mefloquine and Atovaquone/Proguanil.

Doxycycline, sold as Doximal and Doxitab, is a broad-spectrum antibiotic that’s not suitable for pregnant or nursing women or children under eight. Side effects are similar to other antibiotics and may includediarrhoea, nausea and increased sensitivity to sunlight.

It’s believed Doxycycline may interfere with the contraceptive pill, although this has never been proven. However, doctors and pharmacists still recommend alternative contraception, such as condoms.

Doxycycline costs from R1 to R3 a tablet. One 100mg tablet should be taken daily with a full glass of water from one or two days before arriving until four weeks after leaving the malaria area.

Tip: Wear high-factor sunscreen to protect against sun-sensitivity and minimise stomach upset by taking it standing upright after meals, with plenty of water. Avoid milk products and antacids, as calcium, magnesium and zinc prevent the drug being absorbed.

Mefloquine, branded as Larium or Mefliam, is controversial because of its possible side effects. However, it’s the only anti-malarial safe for children and may be taken for up to a year.

Dizziness, headaches, insomnia and vivid dreams occur in up to 25 per cent of people. Rare reactions include severe depression, paranoia, aggression and seizures. You should be screened for epilepsy, anxiety or psychosis and liver, kidney or cardiac conditions before mefloquine is prescribed. It’s also not recommended if you’re planning to go scuba diving, mountaineering or pilot an airplane.

Mefloquine costs from R10 to R15 a tablet. Dosage is one tablet weekly from one to two weeks before until four weeks after possible exposure.

Tip: Start the course three weeks before departure so that if you experience side effects, you can switch to Doxycycline or Malanil.

Atovaquone/Proguanil, sold as Malanil in South Africa and elsewhere as Malarone, has only been commercially available since 2000. Side effects are supposed to be less severe, but it’s more expensive. It’s not suitable for children, pregnant or breast-feeding women and shouldn’t be used for trips lasting longer than a month. If you do experience side effects, they’re likely to be headaches, nausea and diarrhoea. Less common problems are dizziness, insomnia, fever and coughing.

Malanil costs from R40 to R45 a tablet. You must take one tablet daily from one or two days before exposure until seven days after leaving.

Tip: Taking these tablets with food or a milky drink makes them more effective.

How well do they work?

Although there are other products claiming to prevent malaria, only the three above have been scientifically proven to be 90 per cent effective in Southern Africa.

No drug is guaranteed to prevent malaria, but even when chemoprophylaxis doesn’t avert the disease entirely, it does reduce its severity. That’s because anti-malarials work by killing off parasites as they enter your bloodstream. (This is also why there’s a myth that prophylaxis can ‘mask’ symptoms.)

You should decrease your risk further by protecting yourself against bites with insect repellents containing DEET, treated bed nets and long, light-coloured clothing.

Be aware that if you get a fever one week to three months after visiting a risk area – regardless of whether you used prophylaxis or saw mosquitoes – it could be malaria. Get tested immediately. Home test kits are easy but test only for P. falciparum and not the other less harmful types. Early treatment is essential to prevent severe illness or death.

Originally published in the May 2009 issue of Getaway Magazine.

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