Asia Malaria: Better Pills

 Re-printed from Farang Magazine - September-October 2001

To hear some people tell it, the untamed jungles of Southeast Asia are malarial hotbeds just waiting to strangle the life out of the innocent traveler.

Western doctors, in addition to warning you not to eat street food (even banana pancakes?), more often than not prescribe expensive anti-malaria pills to keep you disease- and worry-free on your hill tribe trekking adventure. But are they worth the money, do they work and do they really make you psychotic? Will gin and tonic help?

Serial Killer Malaria is caused by protozoal parasites injected by mosquitoes that are active from dusk till dawn. After infection, it can take from six days to several months before symptoms appear -- generally recurrent fevers. Infection enlarges the spleen and liver and in its most severe forms, capillaries in the brain become blocked and the patient dies. Treated in time it is usually not fatal.

The Risks:

According to the WHO, It affects about 10,000 travelers a year - mostly those visiting African and South American countries. The risk is medium-low in this part of the world and virtually non-existent in the cities. If you aren't venturing into the jungle for any length of time, drugs shouldn't be necessary.

The Drugs:

There are a handful of drugs used against malaria. They all work (or don't work) by destroying the parasite in its earliest stages - at the time of infection. But since the parasites keep mutating, none of them provides 100% protection.

Doxcycline, an antibiotic, has to be taken every day. It is quite effective, cheap and has minimal side effects.
Mefloquine, or Lariam is the most popular and is said to be effective, but causes noticeable side effects in 25% of the people who take it. Many travelers who have taken this drug complain that it causes anxiety attacks and wicked nightmares.

Chloroquine is an antimalarial which is no longer effective in this region except the Philippines. Malarone is a new one, so the jury is still out, but the manufacturer's website, not surprisingly, makes it sound wonderful. You take it once a day and it costs a pile.

Up to You

Nobody wants to risk a lawsuit (your own doctor least of all) by telling you not to take these drugs, so weigh it out for yourself, but we will venture to say that there is a bit more paranoia (some of it Lariam induced) surrounding this disease than is probably necessary.

Don't let the bugs bite

Your first and most effective line of defense is not getting bitten. Slather on a repellant with at least 35% DEET, which will also protect you from Dengue fever (see Dr Piyawan's column, opposite page), and cover up in the evenings as much as you can. And while you're at it, have a few glasses of gin and tonic - it won't prevent malaria, but it will make for a happier, worry-free holiday.