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~Malaria and Me~
I have taken anti-malaria tablets at least once a year for the last sixteen years. I've tried every type available in the UK. I've had Chloroquine (aka Avloclor) and Paludrine which I'm going to describe today. I've used Lariam (aka Mefloquine), the ultra effective but potentially quite dangerous super-anti-malarial which gave me anaphylaxis after the second trip I used it on. I once tried the antibiotic doxycyline (never again) and I eventually settled on my favourite, the very expensive Malarone (aka Atovaquone/Proguanil) which is now my anti-malarial of choice. I mention this medicine-cupboard list of products to make two points - firstly that malaria prevention is NOT a 'one drug suits all' issue, and secondly to show that I have a broad experience of pretty much everything that's available and so write from a perspective of having tried the lot.
~Chloroquine and Paludrine~
Chloroquine and Paludrine (I'll call it C&P from now on) is a combination of two drugs taken in separate tablets. I have always bought them in combi-packs - usually with enough tablets to cover a two-week holiday and typically for a price of around £15 to £20 per person. Each 'strip' of tablets contains seven days worth of tablets - a total of sixteen tablets. These are fourteen of Paludrine (two per day for adults) and two of chloroquine (two taken once per week). I believe the 'two per day' approach means that the dose can be adapted for children. The tablets are 'scored' to make them easier to break in half and the child dose is age-dependent and varies from half a tablet to one and a half.
Now for the bad news. You need to take these tablets for one week before you go into a malaria area, for the duration of your visit and then for a massive four weeks after you return. A two week trip therefore needs seven weeks of taking these tablets. A one week trip needs six weeks. Your tan will be faded long before you finish the pack.
The tablets should be taken at roughly the same time each day, ideally after eating. Taken on an empty stomach they can cause nausea. Also keep in mind that if you're already feeling rough or have had a tummy upset, you may struggle to keep down enough food to take with these and that could affect their effectiveness.
These are not little tablets - they're really quite big chunky things - and after a while you may start to wonder if you'd rattle if you were shaken. As a result of this long period of use I had a really bad habit of giving up long before I ought to when I used to take these. My house is littered with random strips of C&P from holidays and business trips where I came home, decided I'd not been bitten once whilst I was away, and then gave up after a week or two. I think it goes without saying that you should not do this! I also had a major problem when I was travelling a lot to malarial areas for work and if I'd taken C&P I would have been on them almost constantly as the next trip would come along before I'd finished the tablets from the last one. As long term usage can have some unpleasant side-effects (including problems with your eye-sight) and as I soon worked out that I could charge my nicer Malarone tablets to my expenses, I dropped C&P after a few years. My husband also gave up on C&P because the paludrine gives him a gippy tummy and in the final weeks tends to make him throw up. We concluded that economising on anti-malarials and then feeling crappy for four weeks after our holidays just wasn't worth it.
~Show me the MONEY!~
There are two key reasons why a lot of people use C&P. The first is that it's the only anti-malarial which is available over the counter in the UK without a prescription and the second is that it's cheap. By contrast a supply of Malarone for a two week holiday will cost around £80 per person - four or five times more than C&P. If your GP advises that this is all you need and you are going to an area with low malaria risk then it's not a bad choice. Unfortunately its OTC availability does tend to also make it the choice of those travellers who totally forgot they needed to take precautions until the last minute and who can't be bothered to go to the GP and get proper advice. Every year 2000 Brits pick up malarial on their travels. Many have gone without any malaria prophylaxis but some take C&P in countries where it's just not effective, or don't start the treatment early enough, get malaria and become very ill (or even die). Ask yourself one question - if this stuff was really effective, why would the drug companies still be working on better stuff that's much more expensive. If it was the best you can buy, would they let you buy it in Boots?
Sadly the answer is that C&P is only suitable for certain parts of the world and it's really only a good choice if your destination is one of those relatively low-risk areas where the drugs are still effective. Mosquitoes in much of the world - including most of sub-Saharan Africa - have developed resistance to chloroquine and these tablets are almost totally ineffective. As a GP once told me, if you're going to Africa with C&P you might as well take 'Holy Water' as it's probably just as effective. Thus, even if you take the time to plan your travel medicine well in advance, you really do need to check that C&P will work in the place you're going to.
After a decade and a half of travel to risky areas, I consider myself to be probably better at working out what I need for where I'm going than most of the staff at my local health centre - in fact they worked that out too and now I just ring when I want a prescription of Malarone and they don't even bother making me go in for an 'advice' session. It helps of course that I'm taking the most expensive and most effective drug currently available - and they're selling it to me. If you aren't so experienced then PLEASE book an appointment at your GP or travel clinic if you have one nearby and get proper advice, as well as checking which inoculations you need for your destination. Ideally you should do this six to eight weeks before travel but if you have less time, it's still important to go and get advice as soon as you remember.
You can buy your C&P tablets online or over the counter BUT all anti-malarials have side effects and each is unsuitable for people with certain medical conditions. I think it would be well beyond the scope of a consumer review to advise on health conditions which may be contraindicated, but your GP should be familiar with your health needs and conditions better than a pharmacist or an on-line doctor. If you go to your GP they will also then have on their records what you took and be aware where you've been which might be a life-saver if you come back from a trip, get malaria without realising and the collapse somewhere and medics don't know where you've been or what you took (Yes, I know, it's a bit dramatic but it can and does happen!)
~The safest way to avoid malaria is not to get bitten~
Even the best anti-malarial tablets are at best 90% effective so just because you're taking them doesn't mean you can merrily sit by the lake in your strappy t-shirt and shorts, sipping cocktails and watching the sun go down whilst being eaten alive by mosquitos. Taking precautions against bites will make your anti-malarial tablets all the more effective. I've listed a number of websites that offer great advice at the end of this review but basically cover up at dusk and after dark, wear a good quality insect repellent, and if mosquito nets are provided, use them.
Dooyoo reviews don't seem to accept weblinks so I can only give you the names of the recommended sites and hop you can find them
Fitfortravel.nhs.uk - Contains malaria 'maps' highlighting risks in different countries and different areas within those countries.
www.malariahotspots.co.uk -Full of really good advice on preparing for your trip, how to avoid getting bitten, and how to spot the signs of Malaria.
www.malariatablets.org.uk - this is a site which 'sells' various tablets via an online doctor service. I wouldn't recommend buying in that way BUT it does list all the contraindications for each of the types of anti-malarial tablet, compares their costs, and tells you about possible side effects.
www.traveldoctor.co.uk/malaria.ht​m - Comprehensive advice on which medication for which country and relative risks.