Which Malaria Preventive Do You Use In Risk Areas: Mexico & Central America?

[DandyDon]

Please note that this poll is for Risk Areas below 1,000 meters, etc - not for Cozumel or other non-risk areas.

Yeah, I know - most don't bother, but the CDC recommends doing so an I trust their opinion more than I do the non-medical-professional, so I do. And I've never had a problem, other than remembering to take the weekly med for 4 more weeks after return - but some people do. Except it seems that those who do are taking different meds than I am.

For Malaria risk areas of mainland Mexico and Central America down to the border of Panama, the CDC recommends chloroquine...
Health Information for Honduras | CDC Travelers' Health

Drugs to Prevent Malaria (Antimalarial drugs)

If you will be visiting a malaria risk area in Honduras, chloroquine is the recommended antimalarial drug.

Malaria risk area in Honduras: Risk throughout the country at altitudes below 1000 m (<3,281 ft) and in Roatán and other Bay Island. Risk exists in the outskirts of Tegucigalpa and San Pedro Sula.

And I agree, it's best to discuss this with a physician knowledgeable in this area, but such doctors are not that common, and besides - I like to take a proactive approach in such things, be armed with my own research before I do so. I also have to wonder about some of the experts prescribing different drugs than chloroquine for these trips? It is fortunate that these area are considered without Chloroquine-Resistant P. falciparum, but it seems that some divers are being given the other meds for areas with Chloroquine-Resistant P. falciparum, having problems, and then not using any meds on future trips.

My physician is very well regarded here, originally from Mexico and still returns to practice there - but in a part with no Malaria risk, so I took the CDC recommendations with me when I consulted him - and he agreed with chloroquine. I then had a problem with a new druggist at my pharmacy as he substituted one of the meds for Chloroquine-Resistant P. falciparum because he had it in stock but not the chloroquine. I refused it, he ordered the chloroquine for me, and we've got along fine since.

 

[fisherdvm]

I think some people opt not to take them. When I took them, I think you have to wait like 2 years before you can donate blood. Within taking them, you are on the hold list for only 1 year.

 

[wve]

To continue the conversation that we were having in another thread about Honduras...

I had noticed that chloroquine was the drug recommended for Honduras. However, my doctor (an Infectious Disease specialist) had prescribed mefloquine.

Now, knowing him, I suspect that he prescribes mefloquine to everybody, regardless of the CDC recommendations. His reasoning may be that mefloquine will cover all types of malaria. If the mosquitoes carrying chloroquine-resistant malaria migrate before the CDC gets the news, then the traveler is still covered.

What about differences in side effects between the two?

Here are the side effects for chloroquine (Aralen): Frequencies not defined:

Cardiovascular: Hypotension (rare), ECG changes (rare; including T-wave inversion), cardiomyopathy
Central nervous system: Fatigue, personality changes, headache, psychosis, seizure, delirium, depression
Dermatologic: Pruritus, hair bleaching, pleomorphic skin eruptions, lichen planus eruptions, alopecia, mucosal pigmentary changes (blue-black), photosensitivity
Gastrointestinal: Nausea, diarrhea, vomiting, anorexia, stomatitis, abdominal cramps
Hematologic: Aplastic anemia, agranulocytosis (reversible), neutropenia, thrombocytopenia
Neuromuscular & skeletal: Rare cases of myopathy, neuromyopathy, proximal muscle atrophy, and depression of deep tendon reflexes have been reported
Ocular: Retinopathy (including irreversible changes in some patients long-term or high-dose therapy), blurred vision
Otic: Nerve deafness, tinnitus, hearing reduced (risk increased in patients with pre-existing auditory damage)

Here are the side effects for mefloquine (Lariam):

Neuropsychiatric events: frequency not defined
Central nervous system: (1-10%) Headache, fever, chills, fatigue
Dermatologic: (1-10%) Rash
Gastrointestinal: Vomiting (3%), diarrhea, stomach pain, nausea, appetite decreased (1-10%)
Neuromuscular & skeletal: (1-10%) Myalgia
Otic: (1-10%) Tinnitus

<1% : Abnormal dreams, alopecia, ataxia, aggressive behavior, agitation, anaphylaxis, anxiety, arthralgia, AV block, bradycardia, chest pain, conduction abnormalities (transient), confusion, convulsions, depression, diaphoresis (increased), dizziness, dyspepsia, dyspnea, edema, emotional lability, encephalopathy, erythema multiforme, exanthema, extrasystoles, hallucinations, hearing impairment, hypotension, insomnia, leukocytosis, malaise, mood changes, muscle cramps/weakness, palpitation, panic attacks, paranoia, paresthesia, psychosis, pruritus, seizure, somnolence, Stevens-Johnson syndrome, suicidal ideation and behavior (causal relationship not established), syncope, tachycardia, thrombocytopenia, tremor, urticaria, vertigo, visual disturbances, weakness

As one can see, they are pretty similar. Consequently, for most people mefloquine would seem to be a safe substitute. But divers aren't "most people."

Divers subject their bodies to stresses and conditions that might alter the metabolism and distribution of pharmaceuticals, and, therefore, might also change the side effect profiles in a negative direction. Let's face it: drug companies don't typically test their drugs on people who have lots of nitrogen build up in their bodies. And they don't test them on people who are breathing higher concentrations of oxygen (eg, Nitrox).

On the other hand, most of these really scary adverse effects occur in people who are taking the drugs for treatment of malaria, which involves taking doses that are at least 5 times the preventive dose.

So who knows? I'm hoping DocVikingo does, and I eagerly await his forthcoming article. (I'm lazy enough to let him do the heavy lifting here. Besides, I'm a relative newcomer whereas he has been doing this a long time...)

Until we learn more, I'm with you. It only takes one bite from the wrong mosquito to get a pretty awful disease. I can put up with a little nausea and bad dreams for awhile, if I have to. Certain drugs are tolerated better by some than by others. Individuals may have to work with their physicians to find what combination or regimen works best for them.

 

[Kevrumbo]

Mosquito Repellent lotion for the skin; Permethrin treatment for clothes; and a compact traveler's mosquito bed net gives a good defense against the Dengue Fever Mozzie.

In addition for an anti-malarial, I just use Doxycycline --an easy RX to get same day; good utility antibiotic as well, treats Staph a. folliculitis which I sometimes have chronic problems with during a long liveaboard dive trip in the tropics.

 

[diveprof]

chloroquine. Plus a few shots of 100% agave tequila to be sure.

 

[vladimir]

I had noticed that chloroquine was the drug recommended for Honduras. However, my doctor (an Infectious Disease specialist) had prescribed mefloquine.

Now, knowing him, I suspect that he prescribes mefloquine to everybody, regardless of the CDC recommendations. His reasoning may be that mefloquine will cover all types of malaria. If the mosquitoes carrying chloroquine-resistant malaria migrate before the CDC gets the news, then the traveler is still covered.

I am certainly not qualified to question the judgement of an infectious disease specialist. Perhaps the CDC is weighing the benefit of mefloquine to the individual patient vs. the cost of helping spread mefloquine-resistant malaria to the whole population. From a public-health perspective, saving the big-gun medication until it's needed might make more sense.

 

[vladimir]

In addition for an anti-malarial, I just use Doxycycline --an easy RX to get same day; good utility antibiotic as well, treats Staph a. folliculitis which I sometimes have chronic problems with during a long liveaboard dive trip in the tropics.

My understanding is that Doxycycline is indicated in cases where Mefloquine is not an option. Does your doctor prescribe Doxycycline for prophylactic use against folliculitis? Again, I am not qualified to question his judgement, but it seems like a recipe for breeding resistant bacteria.

 

[fisherdvm]

In addition for an anti-malarial, I just use Doxycycline --an easy RX to get same day; good utility antibiotic as well, treats Staph a. folliculitis which I sometimes have chronic problems with during a long liveaboard dive trip in the tropics.

Unfortunately, Doxy is one of the most photosensitizing agent we have. Don't want to be out in the sun too long without a good sunscreen. Miss a spot, and you'll burn.

Doxycycline is a good antiinflammatory agent, and is used for the long term treatment of acne. It is possible that you might not have Staph aureus folliculitis, but rather have pustular acne. My gut feeling is, long term use of doxycycline will result in Staph resistance within a few months.

I usually tell my patients to stop their doxycycline prior to going on a tropical vacation - so they don't get burned.

 

[reefduffer]

I put down "other" to force an explanation.
On our recent trip to Belize, I checked the CDC website. It said Chloroquine. We took Cloroquine. We didn't consult an infectious disease specialist, and I'll bet the doctor who wrote the Rx would have to google Belize to know where it is.

Your poll didn't have an option for "Whatever CDC recommends" and I thought it would be misleading to just select "Chloroquine". If I next took a trip to Mexico and CDC recommended something else, that's what I'd take.

 

[DandyDon]

I think some people opt not to take them. When I took them, I think you have to wait like 2 years before you can donate blood. Within taking them, you are on the hold list for only 1 year.

Nope, don't think so. American Red Cross

To continue the conversation that we were having in another thread about Honduras...

I had noticed that chloroquine was the drug recommended for Honduras. However, my doctor (an Infectious Disease specialist) had prescribed mefloquine.

Now, knowing him, I suspect that he prescribes mefloquine to everybody, regardless of the CDC recommendations. His reasoning may be that mefloquine will cover all types of malaria. If the mosquitoes carrying chloroquine-resistant malaria migrate before the CDC gets the news, then the traveler is still covered.

That was one of my guesses. I am not qualified to discuss that approach or the side-effects other than to say that I've never known anyone on the med suggested by the CDC who complained of the effects, but I have heard of those taking the other report problems with some frequency - enough to discourage any med uses among others or themselves. If I'd read your post in the other thread before my first trip to Roatan, I might not have taken anything. An actual knowledge of the frequencies would be interesting. Looks like you didn't for for Lariam? Also seems I am the only one so far following CDC guidelines.

Mosquito Repellent lotion for the skin; Permethrin treatment for clothes; and a compact traveler's mosquito bed net gives a good defense against the Dengue Fever Mozzie.

In addition for an anti-malarial, I just use Doxycycline --an easy RX to get same day; good utility antibiotic as well, treats Staph a. folliculitis which I sometimes have chronic problems with during a long liveaboard dive trip in the tropics.

Okay the repellent, insecticide clothing treatment, and netting are good ideas - aside from that we are asked to not use DEET or Permethrin when diving. Otherwise, you're using Doxycycline as a prophylactic.

I am certainly not qualified to question the judgement of an infectious disease specialist. Perhaps the CDC is weighing the benefit of mefloquine to the individual patient vs. the cost of helping spread mefloquine-resistant malaria to the whole population. From a public-health perspective, saving the big-gun medication until it's needed might make more sense.

I'm not qualified either, but that's my feeling.

My understanding is that Doxycycline is indicated in cases where Mefloquine is not an option. Does your doctor prescribe Doxycycline for prophylactic use against folliculitis? Again, I am not qualified to question his judgement, but it seems like a recipe for breeding resistant bacteria.

Unfortunately, Doxy is one of the most photosensitizing agent we have. Don't want to be out in the sun too long without a good sunscreen. Miss a spot, and you'll burn.

Doxycycline is a good antiinflammatory agent, and is used for the long term treatment of acne. It is possible that you might not have Staph aureus folliculitis, but rather have pustular acne. My gut feeling is, long term use of doxycycline will result in Staph resistance within a few months.

I usually tell my patients to stop their doxycycline prior to going on a tropical vacation - so they don't get burned.

Tell me! I took it on my first Hawaii trip and snorkeled all afternoon. Ouch!

I put down "other" to force an explanation.
On our recent trip to Belize, I checked the CDC website. It said Chloroquine. We took Cloroquine. We didn't consult an infectious disease specialist, and I'll bet the doctor who wrote the Rx would have to google Belize to know where it is.

Your poll didn't have an option for "Whatever CDC recommends" and I thought it would be misleading to just select "Chloroquine". If I next took a trip to Mexico and CDC recommended something else, that's what I'd take.

Setting up a poll that will communicate the questions effectively for accurate results can be a challenge. That's the way I have done it, so I voted Chloroquine. I'm not clear on why you chose other? The qustion was "which do you use?" Not "which were you precribed."