Since we are slowly nearing 25th of April which is dubbed as World Malaria day, I thought I would explore some malaria topics that are extremely important but for some reason are less talked about. And this topic is malaria medication or antimalarial medication, which is the main thing that will protect you from getting this mosquito-borne disease in places that are known for malaria-carrying mosquitoes.
Although many times drugs that cure malaria also are called antimalarials, mainly this term is referred to malaria prophylaxis drugs, and there are multiple different antimalarial drugs designed for different situations and cases. But no matter which drug you or your doctor decides for you to use, there are a few things that you need to consider before you start any drug course.
The first thing to remember is that no drug meant for malaria prevention is and ever will be 100% protective meaning that there is still a chance to get infected with malaria even if you are taking antimalarials. Granted these drugs do increase the ability of your body being able to prevent malaria if you get bitten by a mosquito that is a carrier for this virus by at least 90 percent, but still antimalarial drugs aren’t 100% like hardly anything in the world is. So you need to combine the antimalarial drugs with using personal mosquito protection measures like using insect replants, using a mosquito net while sleeping and wearing long sleeves and long pants so the mosquitoes cannot come in contact with your skin and bite you.
The second thing to remember is that because antimalarials are drugs, if you are using any other medicine, the malaria drugs can react to that other medicine either weakening the effects of either of the drugs or in worst case causing drug allergies or other health complications. So defiantly consult with your doctor about the antimalarial drugs and their possible interaction with other medicine you are taking.
And thirdly you also need to do research as to which antimalarials you should be taking and which are available in the country you live in. The malarial drug offer and recommendations differ from country to country so you might not get a specific brand of antimalarials in one country or another. Also you should check the antimalarial drug recommendations of the country you will be traveling to, because in most cases the doctors and scientists of that country know more about their country and the mosquitoes and malaria strains in their country so they are fitter to make those recommendations. And this also can make your decision process as to which malaria drugs to use easier. Now lets look at the five CDC recommended antimalarial drug types and in which case you should use which drug.
This is an antimalarial drug that is suited for those who are going on last minute trips to countries where there are malaria-carrying mosquitoes and those who are going for shorter trips to these countries, because you need to start taking this medicine only 1 to 2 days before traveling and you need to continue to take them only 7 days after you have returned home. And although you will have to take these pills daily, they might cause upset stomach for some and these drugs cannot be used during pregnancy, by woman who are breastfeeding and by people who are known to have glucose-6-phosphatase dehydrogenase (G6PD) deficiency, they are the most effective drug to prevent P. vivax also known as the parasite that causes recurring malaria which is the most widely distributed human malaria strain. So if you are going to South and East Asia, Western Pacific, Eastern Mediterranean regions, or South and Central America and the Caribbean, which respectively are the places besides Africa with the most P. vivax malaria cases, then you should think about using this antimalarial medicine.
- Atovaquone / Proguanil (Malarone)
The second drug that is recommended for last minute travelers and those who take short trips to countries with known malaria cases, because you can start taking this medicine only 2 to 1 days before your trip and stop taking the pills 7 days after you have returned from your travels. The downside of these type of drugs is that you will have to remember to take the everyday, they cannot be used by pregnant woman or women who are breastfeeding children, or people with severe renal impairment as well as this medicine tend to be pretty expensive. But since this is a very well tolerated medicine and there are no side effects known from it, then maybe it is worth the cost.
One more antimalarial drug that you will have to take every day starting 2 to 1 days before your trip to a country with malaria mosquitoes but that will be inexpensive yet efficient is Doxycyline. With these drugs you can not only prevent malaria but also some other infections, so this medicine is perfect for those who will he hiking, swimming or doing any other activity that can cause an infection. Just remember that Doxycyline cannot be taken during pregnancy and by children younger than 12 years, you will have to continue to take these drugs up to 4 weeks after you have returned home, so you might not want to take this medicine if you are going for a short trip, and it can cause sun sensitivity or upset stomach, which can dampen your vacation plans. But the good thing is that if you have acne and your doctor has recommended you some medicine for it you might be already taking Doxycyling, in which case you do not have to take any additional malaria prevention medicine.
Then there is Chloroquine that is a weekly drug you start taking one to two weeks before you go on your trip and continue to use 4 weeks after the traveling. This means that this antimalarial drug will be perfect for long trips and planned vacations because you will have to remember to take this medicine only once every week and start taking it few weeks before your trip. On top of that Chloroquine can be used in all trimesters of pregnancy and some people with rheumatologic conditions might be already using this medicine so they are already protected against malaria. The downside of this drug? It might exacerbate psoriasis and you shouldn’t use it in areas with known chloroquine or mefloquine resistance or where there are mosquitoes that carry Plasmodium falciparum and P. vivax strain malaria, because these two malaria parasites are resistant to Chloroquine and the use of chloroquine in these areas will be pointless.
- Mefloquine (Lariam)
And lastly there is a weekly antimalarial medicine called Mefloquine or Lariam that is great for those who are taking longer planned trips, because you can take these drugs only once a week starting with no less than 2 weeks prior your trip and ending the medicine course 4 weeks after you have come back home. This medicine, too, is safe to use during pregnancy, but it is not recommended to use it in areas where mosquitoes are known to be resistant to Mefloquine (areas with Plasmodium falciparum and P. vivax malaria strains), and to be used by people with some psychiatric conditions, seizure disorder or cardiac conduction abnormalities.
So really when you are choosing antimalarials to use during your next trip first consider where you are going and think about your health, other medicine you are currently taking and your medical history so you don’t take antimalarial drugs that will harm your health. Secondly, also consider your and your children’s age that will be taking the antimalarial medicine and women should make sure that they are not pregnant so you don’t harm your child by taking drugs that are not suited for pregnant woman. Thirdly, think about the length of your trip, if it is planned or spontaneous and will you have enough time before the trip for the medicine to kick in. Then make sure you know what kind of possible side effect the antimalarials could cause and make sure you are prepared for them. And lastly of course also keep in mind the dosage of the antimalarial drugs you choose so you don’t skip any dosage and don’t make yourself vulnerable to malaria. Once you have weighted the pros and cons of all these points then the decision as to which antimalarial drug you should use for your next trip, should be easy.