Oceanshutter 121 Posted August 9, 2014 Hello everyone, I am headed to PNG in a couple of weeks. Based on research from Wetpixel as well as other places. It seems Malerone is the most popular malaria prevention. However, my wife went to the doctor yesterday and he refused to prescribe it based on side effects. It seems that with a lot of people it can cause depression not just while you are on it, but long term. Anyone else had issues with this? He has instead prescribed Doxycycline. Which is still on the approved list for malaria from the CDC. Thoughts? Dustin Share this post Link to post Share on other sites
Macdaza 2 Posted August 9, 2014 (edited) Dustin, All drugs have some side-effects, and based on my experience, Malarone is the best. The 3 drugs that I've been prescribed for diving in malaria zones are: Malarone, Doxycycline, and Lariam. Doxycycline increases sun-sensitivity, and while I've used it, it was a bad choice while on the equator and constantly exposed to intense water reflection and sun. None of my dive group uses it. Lariam is known to cause neurological and psycholgical symptoms in some people, and as of last year, carries a 'black box' warning from the FDA. Most of us had mood swings on Lariam, some found it unpleasant. Malarone has been known to cause vivid dreams in some people, but when I do a live aboard, those that are taking anti-malarial drugs are always using Malarone, and no one complains about it. Hope this helps, Cameron Edited August 9, 2014 by Macdaza 1 Share this post Link to post Share on other sites
Oceanshutter 121 Posted August 9, 2014 Dustin, All drugs have some side-effects, and based on my experience, Malarone is the best. The 3 drugs that I've been prescribed for diving in malaria zones are: Malarone, Doxycycline, and Lariam. Doxycycline increases sun-sensitivity, and while I've used it, it was a bad choice while on the equator and constantly exposed to intense water reflection and sun. None of my dive group uses it. Lariam is known to cause neurological and psycholgical symptoms in some people, and as of last year, carries a 'black box' warning from the FDA. Most of us had mood swings on Lariam, some found it unpleasant. Malarone has been known to cause vivid dreams in some people, but when I do a live aboard, those that are taking anti-malarial drugs are always using Malarone, and no one complains about it. Hope this helps, Cameron Good Info Cameron. I am wondering if just keeping up on the sunscreen would be okay with the doxycycline? 1 Share this post Link to post Share on other sites
Macdaza 2 Posted August 9, 2014 I suppose sunscreen would help, depending on your skin sensitivity, and how exposed to the sun you are, but quite frankly it seems silly to take a drug that's known to increase sun sensitivity when you know you're going to the equator and are going to be on the water for an extended period of time. Most divers take Malarone because they have acceptable results while using it on dive trips. If it were me, unless the doctor could cite lots of literature supportive of Doxy and against Malarone, I'd get a new doctor. Btw, I've never had a doctor who was adverse to prescribing Malarone. I'm sure you'll have a great time whichever way you go! Share this post Link to post Share on other sites
troporobo 226 Posted August 10, 2014 I'll offer a contrarian approach - bearing in mind that I am not a doctor and don't play one on TV - but I don't use malaria profilaxis anymore and instead rely on repellent, clothing at dawn and dusk, and common sense. I don't suggest that this advice is necessarily applicable to anyone else. It is up to everyone to weigh up their risks under competent medical advice. Having tried several regimes, all had severely undesirable side effects for me, and with a career focused in the tropics I could not continue taking anti-malarials indefinitely. I have not been infected in over 25 years of 6-8 trips a year to PNG, Timor Leste, Solomon Islands, and Vanuatu plus living in Manila where dengue is endemic. Granted I am not sleeping in villages and tramping through the bush (but neither do most divers) but I do spend a fair bit of time outdoors in rural areas on construction sites. The only time I contracted malaria was while living in the Solomons for a couple of years while on profilaxis! I can vouch that it is not something that I would want to repeat but at least it was P. vivax and not P. falciparum, and thus easily cured. Share this post Link to post Share on other sites
davephdv 0 Posted August 10, 2014 At our clinic we have a recognized expert travel doctor. You tell her where your going and she tells you which drug to take. I myself have prescribe doxycycline a number of times. It can cause an allergic reaction to sun exposure. However if your not nursing or under 14 it is safe for most people. Share this post Link to post Share on other sites
Nautilus Cairns 5 Posted August 10, 2014 I do three overseas dive trips a year, all to countries where malaria is present. I've tried doxy a few times and although I have never had a problem with sun sensitivity it did give me a bloated stomach! I now follow Troprobo's approach and rely on using repellent and covering up in the evenings. Also check for insect screens and mossie coils in the accommodation areas. I understand that in PNG some places have a greater risk of malaria than others. I too am not a medical practitioner so this is just my experience Share this post Link to post Share on other sites
AndreSmith 7 Posted August 10, 2014 From this doctor here - Malarone is definitely the best choice. More expensive but totally worth it. Of the three mentioned it has by far the lowest incidence of serious adverse reactions and is overall the best in terms of prophylaxis. Also be aware that Doxycycline can cause severe esophageal burning - seen that several times! Share this post Link to post Share on other sites
Nautilus Cairns 5 Posted August 10, 2014 Also be aware that Doxycycline can cause severe esophageal burning - seen that several times! So you need to have it with food as per instructions! Share this post Link to post Share on other sites
Interceptor121 533 Posted August 10, 2014 I am Italian and used Doxycycline got sunburn that has never previously happened to me Go to a proper travel clinic and get malarone. One person in 1000 looses completely body hair with it but you are not going to be that person hopefully Share this post Link to post Share on other sites
Chasin' Tales 3 Posted August 19, 2014 I work in Africa. When I first started, I got a prescription for malarone. After a month I quit taking it. I have since found out that most of the expat coworkers do not take any prophylactic anti malarial meds. Prevention is the key. Picaridin bug spray and long sleeves and pants when possible. As far as I know, malarone is used also to treat malaria...not sure if this is the case with doxycycline. I would rather get a script for malarone and not take it, but have it just in case. Regardless, the anti malarials don't protect you from the other mosquito borne diseases. Dengue is no picnic. Making sure you don't get bit is the key. Share this post Link to post Share on other sites
tdpriest 115 Posted August 20, 2014 (edited) Prevention is the key. And cerebral malaria the outcome... ... if you're unlucky. Protection and prophylaxis because, yes, dengue fever is nasty, too. I am not a doctor and don't play one on TV Nor is anecdote a substitute for evidence. The advice from colleagues in Infectious Diseases Medicine is protection and prophylaxis. I use malarone where it is appropriate because doxycycline is substantially more unpleasant in my experience. I'm pretty sure that this conversation recurs on Wetpixel every couple of years. Edited August 20, 2014 by tdpriest 1 Share this post Link to post Share on other sites
MitHere 3 Posted August 21, 2014 AFAIK, malarone is not the treatment upon contraction of malaria (I got ~600 mosquito bites in the Amazon thinking that it did and thus didn't bother covering up, haha) but I think it helps in the beginning? I'm not sure, really - this is why you pay a professional to advise you rather than a bunch of nerds Or you could look at it this way - roll the dice! But as I get older and have more people (Well, it's been my girlfriend for the past ~5 years) to care about the more I realise I don't want to say goodbye so it's perhaps worth it to be safe and not be as cool. Your chances are pretty slim, though... Share this post Link to post Share on other sites
troporobo 226 Posted August 21, 2014 (edited) Great advice, if you travel only occasionally. Coming from a family of tropical medical experts, I am fairly sure that their advice also includes a caution against profilaxis more or less continuously for years or even decades. That's why I use one and not the other. It isn't advice for everyone, it all depends on specific circumstances. The advice from colleagues in Infectious Diseases Medicine is protection and prophylaxis. Edited August 21, 2014 by troporobo Share this post Link to post Share on other sites
Oceanshutter 121 Posted August 21, 2014 Thanks everyone for the advice. I needed up getting a prescription for malerone (generic). I will start taking it today, and continue until 2 weeks after I get back from png. No long term use. I also have mosquito spray already packed. Hopefully I won't need it much! Want to be underwater most of the time. Thanks again, Dustin Share this post Link to post Share on other sites
Oceanshutter 121 Posted August 21, 2014 (edited) Well, I just took the first Malarone pill a few hours ago....gotta say, I feel a bit dizzy. Anyone with experience, does this get better after a day or so? If not, the doxycycline might need to take over. Edited August 21, 2014 by Oceanshutter Share this post Link to post Share on other sites
