Anti-Malarial

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Diver Lori

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I'm going to Roatan at the end of August. I've read several trip reports on how the mosquitos, amongst other flying biting bugs are horrendous.

My question. Anti-Malarial. Should I? and do I have enough time before leaving? Isn't it a multi-dose regimen? Are their significant side effects?

TIA!

Lori
 
As the first step in malaria prevention is to avoid being bitten by mosquitoes, you might find this helpful. It's an updated edited version of my "Ask RSD" column in the Oct '99 issue of "Rodale's Scuba Diving."

"Sand fleas & mosquitoes can be a real bother, not to mention that they are sources of some serious tropical diseases.

The danger & bother of insects can be substantially reduced by these precautions: (1) Wear long sleeves and pants, avoiding dark or bright colors, especially at dawn and dusk. Protective clothing such as the "Buzz Off" brand can be useful. As an extra precaution, you may treat clothing with permethrin (As in the easy to use Sawyer Products http://www.permethrin-repellent.com ) ; (2) Try to stay indoors at dawn and dusk when many flying insects are most active, and avoid sandy areas as much as possible at any time of day, especially when there is no breeze. When making reservations, make sure the resort has screened windows; (3) Wear insect repellent. The best protection against these and other insects is full strength DEET. Some divers like things such as Avon's Skin-So-Soft & Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for lasting effectiveness. Most DEET containing repellents are the 15-30% range of concentration. The testing of various strengths of DEET has shown that after about 30% little additional effectiveness is to be had by upping the strength, and even less after about 50%. As such, there is simply no point in exposing oneself to more potent brews. UltraThon at 32% http://www.3m.com/us/home_leisure/ultrathon/ appears to be a good product. Used as directed over relatively brief periods of time, say a week, DEET has been shown to pose no significant risk when applied to exposed skin. If you wear lightweight, loose fitting clothes, it generally is safe to use DEET underneath. Doing so with heavy, snug fitting clothes can result in dermatological problems & worse. Be aware that DEET can dissolve synthetics like plastics, rayon & nylon, so it's best to wear natural fibers & keep it off of your gear; (4) Avoid scented toiletries and perfumes; (5) Upon arrival, treat your room with a bug bomb such as Shelltox or Fish (stay outside while this is being done). Touch up with spray after that as needed."


As for malaria, there definitely are reported cases of malaria on Roatan, although to the best of my knowledge not at a high incidence rate. The majority of divers I know who frequent Roatan do not take malaria medication prophylactically if they are not planning to go over to the mainland for touring.

As with many things in scuba & foreign travel, the level of risk one is willing assume is a personal decision. However, malaria is a nasty disease, and the conservative CDC guidelines would be appropriate for those wishing to reduce risks to a very low level. These can be found by clicking here----> CDC Travelers' Health--Health Information for Travelers to Mexico and Central America http://www.cdc.gov/travel/camerica.htm .

If one decides to take an anti-malarial prophylactically, care must be taken in choosing the drug as some may not mix well with scuba, e.g.,----> Concerns About Lariam http://dive.scubadiving.com/talk/re...204092&t=203844 . At present, chloroquine (e.g., Aralen) is largely recommended for the Honduras, and it tends to be tolerated well & to pose little threat to scuba.

If you decide that malaria chemoprophylaxis may be for you, contact your nearest tropical diseases/travel medicine clinic. They'll get you squared away. And, don't wait until the last minute. The following websites may be of assistance in locating such a facility:

International Society of Travel Medicine http://www.istm.org

American Society of Tropical Medicine and Hygiene (ASTMH)
http://www.astmh.org/scripts/clinindex.asp

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Yes, you have more than adequate time to begin chemoprophylaxis before you depart in late Aug.

Best regards.

DocVikingo
 
Lori, it's a once a week pill with little likelyhood of problems if taken on full stomach. First dose a week before you leave, last dose 4 weeks after returning. Not as important as seat belts, but a good idea...
 
How do you know what the dosing schedule is when you have not mentioned any specific drug nor has Diver Lori yet been prescribed anything?

Thanks,

DocVikingo
 
DocVikingo:
How do you know what the dosing schedule is when Diver Lori has yet to be prescribed any specific medication?

Thanks,

DocVikingo

If you do a search on the net all the dosages for the well known prescriptions are published, I new what mine would be before I ordered them from the Dr.
 
I have an appt with my internist next Wednesday to discuss Hep A, chloroquine, ear drops for swimmers ear, and oral scop. My dive buddy went to his yesterday and was given Hep A vaccination & a script for chloroquine. (he was told he only needed Hep B if he was planning to have s_x with the locals!! EEK!) I got otitis externa in both ears last year after cave diving in Akumal last December....even after using preventative alcohol/vinegar.

I'm also hoping that a derm allergic reaction to scop patchs doesn't preclude me from taking oral scop. We'll see what she says next week. I've got my fingers crossed. I got on the stick and made an appt with her right away in case I opt to do the preventative for malaria.

I'll also need to talk to the pharmacist about interactions between scop & malaria preventitive too...if any.
 
Yes, of course recommended dosages can be looked up, but first one needs to know which drug is being prescribed. Diver Lori has yet to see her physician and receive a prescription. Am I missing something here?

Also, one's physician may for one reason or another direct that a medication be taken in doses different from those recommended by the manufacturer or some other source.

Best regards.

DocVikingo
 
DocVikingo:
Yes, of course recommended dosages can be looked up, but first one needs to know which drug is being prescribed. Diver Lori has yet to see her physician and receive a prescription. Am I missing something here?

Also, one's physician may for one reason or another direct that a medication be taken in doses different from those recommended by the manufacturer or some other source.

Best regards.

DocVikingo

not missing anything but I got the impression that Don was quoting a particular medication, and he was right about the dosage for the average person. I think side effects, cost and how often/long one takes medication is usually factored into a decision of what drug to take when you have a choice of drugs.

All the Best
David
 
Diver Lori:
I'm going to Roatan at the end of August. I've read several trip reports on how the mosquitos, amongst other flying biting bugs are horrendous.

My question. Anti-Malarial. Should I? and do I have enough time before leaving? Isn't it a multi-dose regimen? Are their significant side effects?

TIA!

Lori


Lori,

I went to Eastern Tanzania (Africa) a year ago. My doctor gave me Malarone. It is a newer drug that is more effective with fewer side effects (I had none) Unlike Lariam (The old drug) which you take for a week before and four weeks after, you start taking Malarone a day before you arrive and take it for a couple of days after you return. IMHO I would get a prescription. Although the incidence rate for Malaria in Roatan is low why risk it?? Malaria can be a very mean bug. The links below will tell you more about the drug and the other choices available. Hope this helps

http://www.cdc.gov/travel/malariadrugs.htm
http://healthlink.mcw.edu/article/979237802.html
 
outlawaggie:
Lori,

I went to Eastern Tanzania (Africa) a year ago. My doctor gave me Malarone. It is a newer drug that is more effective with fewer side effects (I had none) Unlike Lariam (The old drug) which you take for a week before and four weeks after, you start taking Malarone a day before you arrive and take it for a couple of days after you return. IMHO I would get a prescription. Although the incidence rate for Malaria in Roatan is low why risk it?? Malaria can be a very mean bug. The links below will tell you more about the drug and the other choices available. Hope this helps

http://www.cdc.gov/travel/malariadrugs.htm
http://healthlink.mcw.edu/article/979237802.html

My wife and I also took Malarone for our trip to PNG and had no side effects
 

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