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Thursday, June 18, 2009

Preventive Medication For Malaria

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• The objective of preventive medication is to prevent death caused by Plasmodium falciparum Malaria.
• No drug is 100% effective in preventing Malaria.
• Drugs do not prevent initial infection. Mosquitoes still bite and parasites will be transferred to your blood stream.
• It is reasonable not to take Malaria preventive drugs if you are only visiting a Malaria area for up to 3 days: Obsessive mosquito protection should be sufficient.
• The choice whether or not to take preventive medication is yours.
• Malaria may be up to 10 times more common in those who do not take any drug prevention in known Malaria areas.
• About 50% of people do not take the preventive medication as directed.
• Resistance to preventive drugs is a major problem. Assume all of Indonesia has Chloroquin resistance.
• Which preventive drugs to take depends on many factors. This should be discussed with your doctor.

Early Diagnosis and Treatment:
• Malaria has no specific symptoms eg it can mimic Flu, Pneumonia, Gastroenteritis etc. Shivering, headache & high fevers are common.
• Malaria symptoms usually occur more than 7 days after infection but symptoms may occur weeks or months later.
• ANY fever on return from or while travelling in Indonesia may be Malaria and MUST be investigated within 48 hours of onset. Young children and pregnant women are particularly at risk from Malaria.
See a doctor and insist on a Malaria screen.
• If appropriate treatment is started by the fourth day of illness(not infection) then the adult Malaria patient is not likely to die.
• If you are travelling in an area more than 24 hours from medical help consider taking an Emergency Self Treatment Pack for Malaria. Further treatment on return home will still be necessary. Discuss with your doctor.
• Pregnant women and young children should think seriously about travel in known Malaria areas. Our advice is not to travel unless necessary.

Preventive Malaria Drugs:
Discuss preventive treatment with your doctor well before you leave. Your past medical history, any drug allergies, other medication you are taking, whether you are pregnant and the age of children traveling will influence drug choice.

The most commonly used Malaria preventive drugs are:
1. Doxycycline.
• Dose is 100mg per day starting 2 days before travel and continuing for 4 weeks on return.
• Not suitable for pregnant women and children under 8 years.
• Common side effects: Nausea, indigestion, increased sensitivity to sunburn, thrush in females.

• Dose is one tablet per week taken on the same day each week starting one week before travel and continuing for 4 weeks after return.
• Suitable for pregnant women in the second and third trimesters and can be given to children over 3 months of age but discuss first.
• Common side effects: Nausea, vomiting, dizziness, headaches -usually transient. Occasionally confusion, anxiety, agitation, depression, sleep disorders. Incidence of all side effects is low but discuss with your doctor.

3.Other Drugs:
Fansidar, Chloroquin, Proguanil plus Chloroquin combination are also used but not usually recommended by this clinic. Discuss with your doctor.

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