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long term prophylactic use

long term prophylactic use

Old Oct 9th 2006, 11:25 pm
  #1  
Mikeyc
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Default long term prophylactic use

Can any one help me?

I am going to do a year long project in South Africa and i am trying to
decide what to do about anti malarials, all the reading says take them, wear
long sleves etc. However, i have come accross people and articles that say
long term exposure to these drugs can cause liver and kidney damage, if any
one can offer me any guidence on this i would be very appreciative.

Mike Collins
 
Old Oct 9th 2006, 11:42 pm
  #2  
Marc Lurie
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Default Re: long term prophylactic use

Where will you be in South Africa?

Regards,
Marc

On Tue, 10 Oct 2006 11:25:48 GMT, "mikeyc" <u27709@uwe> wrote:

    >Can any one help me?
    >I am going to do a year long project in South Africa and i am trying to
    >decide what to do about anti malarials, all the reading says take them, wear
    >long sleves etc. However, i have come accross people and articles that say
    >long term exposure to these drugs can cause liver and kidney damage, if any
    >one can offer me any guidence on this i would be very appreciative.
    >Mike Collins
 
Old Oct 10th 2006, 12:14 am
  #3  
Hans-Georg Michna
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Default Re: long term prophylactic use

On Tue, 10 Oct 2006 11:25:48 GMT, mikeyc wrote:

    >I am going to do a year long project in South Africa and i am trying to
    >decide what to do about anti malarials, all the reading says take them, wear
    >long sleves etc. However, i have come accross people and articles that say
    >long term exposure to these drugs can cause liver and kidney damage, if any
    >one can offer me any guidence on this i would be very appreciative.

Mike,

first of all, I'm not a professional in that area, so everything
I write may be wrong. You may have to go to the source. Why not
write to the manufacturer of the prophylactic drug of your
choice and ask about long term exposure, if it's not already
written in the instructions for use? At least ask a specialist
on tropical diseases.

That said, I think you should not take prophylactics for months
or even years. I'm in a similar situation, and when I'm in an
area that has a malaria risk, I do the following.

1. I always carry a treatment dose with me and take it when I
get an inexplicable fever that could be malaria.

2. I always sleep under a mosquito net, unless I'm very sure
that the room is free of mosquitos and that they can't get in.

3. I impregnate my mosquito net with suitable insect repellant
(which probably contains DEET).

4. I wear long trousers and long-sleeved shirts when I'm exposed
to mosquitos.

5. I spray the most vulnerable areas, the ankles, etc., with
insect repellant before I'm exposed to mosquitos.

The result for me has been that I never contracted malaria in
several years in east Africa and took a cure dose only once.
Even then it turned out that it was not malaria.

Hans-Georg

--
No mail, please.
 
Old Oct 10th 2006, 2:16 am
  #4  
Marc Lurie
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Posts: n/a
Default Re: long term prophylactic use

I'd generally agree with Hans-Georg and his post. However, YOU are the
only person who knows YOURSELF and how well you are likely to adhere
to an anti-malaria regime.

If you are a very responsible person and WILL use repellants and nets
etc. then you needn't take prophylactic drugs. Just make ABSOLUTELY
sure that you follow anti-malaria precautions, and if you feel ill,
GET MEDICAL OPINION IMMEDIATELY. I'm not over-reacting here. Malaria
can kill in a matter of days. DON'T mess with this disease.

If you are not totally responsible, then there are drugs that are
reasonably well-tolerated for long periods. Doxycycline is a
broad-spectrum antibiotic that is an effective prophylaxis. It has
been used for many years as a long-term medication for acute acne with
very few side effects.

I must remind you that, even with prophylactic drugs, you will still
need to be dilligent and responsible about regularly taking the drugs.

Of course, it all depends on exactly where you'll be working in South
Africa, and what sort of work you'll be doing. Only a very small part
of the country has endemic malaria.

Regards,
Marc

On Tue, 10 Oct 2006 14:14:10 +0200, Hans-Georg Michna
<[email protected]> wrote:


    >Mike,
    >first of all, I'm not a professional in that area, so everything
    >I write may be wrong. You may have to go to the source. Why not
    >write to the manufacturer of the prophylactic drug of your
    >choice and ask about long term exposure, if it's not already
    >written in the instructions for use? At least ask a specialist
    >on tropical diseases.
    >That said, I think you should not take prophylactics for months
    >or even years. I'm in a similar situation, and when I'm in an
    >area that has a malaria risk, I do the following.
    >1. I always carry a treatment dose with me and take it when I
    >get an inexplicable fever that could be malaria.
    >2. I always sleep under a mosquito net, unless I'm very sure
    >that the room is free of mosquitos and that they can't get in.
    >3. I impregnate my mosquito net with suitable insect repellant
    >(which probably contains DEET).
    >4. I wear long trousers and long-sleeved shirts when I'm exposed
    >to mosquitos.
    >5. I spray the most vulnerable areas, the ankles, etc., with
    >insect repellant before I'm exposed to mosquitos.
    >The result for me has been that I never contracted malaria in
    >several years in east Africa and took a cure dose only once.
    >Even then it turned out that it was not malaria.
    >Hans-Georg
 
Old Oct 10th 2006, 3:13 am
  #5  
Mikeyc
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Posts: n/a
Default Re: long term prophylactic use

Thank you both of you, some very helpful information.

I am going to be in Limpopo province near the town of Hoedspruit if you know
it. My understanding is that it is in an intermediate risk area.

I would consider myself responsible and obviously, i will need to do more
research, but perhaps not using medication is the solution. Thank you both
for your help.

Hans; you mentioned a treatment dose, am i correct in assuming that this is
just a normal course of anti malarials which you take if you feel any
potential symptoms.

Thank you both for your time

Mike Collins
 
Old Oct 10th 2006, 4:09 am
  #6  
Hans-Georg Michna
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Default Re: long term prophylactic use

On Tue, 10 Oct 2006 15:13:55 GMT, mikeyc wrote:

    >Hans; you mentioned a treatment dose, am i correct in assuming that this is
    >just a normal course of anti malarials which you take if you feel any
    >potential symptoms.

Mike,

there is no simple, general answer. Several prophylactic drugs
can also be taken as a cure, in a several times higher dose and
adhering to a special schedule. A totally fictitious example
would be:

Take 3 pills immediately. 2 hours later take another one. 6
hours later take yet another one, then take one per day for
three days.

I have just made this up. Real schedules are different. You have
to read the instructions.

Malarone and Lariam can be taken as a cure, for example. (I once
took the Lariam cure dose, and it was an unforgettable mental
horror trip. Malarone is not so bad.)

However, there are some medications that cannot be taken as a
cure (I believe doxycycline is among them) and some others that
can only be taken as a cure (perhaps artemisinine, but again I'm
not sure). Moreover, some drugs, like for example Malarone, cure
certain kinds of malaria, like malaria tropica (the killer
malaria), but not others, like malaria tertiana (the recurring
malaria that doesn't kill you quickly, but is harder to cure),
so if you take it, you should still visit a specialist hospital
within very few days.

My personal recommendation is Malarone, but that's also the most
expensive anti-malaria drug. However, when you only carry one
pack as a cure, the price is OK, particularly since it doesn't
expire before several years.

Hans-Georg

--
No mail, please.
 
Old Oct 10th 2006, 11:05 am
  #7  
mikeyc via TravelKB.com
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Posts: n/a
Default Re: long term prophylactic use

Thank you Hans

I appreciate all your assistance on this matter

Mike

--
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http://www.travelkb.com/Uwe/Forums.aspx/africa/200610/1
 
Old Oct 10th 2006, 7:35 pm
  #8  
Marc Lurie
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Default Re: long term prophylactic use

Hi Mike,

I know Hoedspruit reasonably well. It is pretty much a seasonal
malaria area with a far lower chance of malaria in the winter months.

The VAST majority of malaria cases in the area are P. Falciparum
(Hans-Georg refers to it as "tropica") and indeed, this is the strain
that is deadly. Early intervention is critical after infection. I know
of far too many people who insist that they merely have 'flu for two
or three days, and then end up in intensive care for a few weeks. A
friend of a colleague has recently spend 6 weeks in intensive care,
and will be undergoing at least 5 months of rehabilitative therapy
after he contracted Falciparum, but neglected to seek treatment for a
week.

If you have easy access to a good hospital in the area, then I
wouldn't worry about carrying a cureative dose, but rather go off to
the doctor if you have any symptoms. All private hospitals in the area
have extensive knowledge of malaria, and they are well-equipped to
handle and treat it.

The female anopheles mosquito (the bitch that carries the parasite),
is usually active around dusk and dawn, so that's when you have to be
most carefull.

If you are carefull with repellants and impregnated nets, the chances
of contracting malaria is small, however not negligable.

Regards,
Marc

On Tue, 10 Oct 2006 15:13:55 GMT, "mikeyc" <u27709@uwe> wrote:

    >Thank you both of you, some very helpful information.
    >I am going to be in Limpopo province near the town of Hoedspruit if you know
    >it. My understanding is that it is in an intermediate risk area.
    >I would consider myself responsible and obviously, i will need to do more
    >research, but perhaps not using medication is the solution. Thank you both
    >for your help.
    >Hans; you mentioned a treatment dose, am i correct in assuming that this is
    >just a normal course of anti malarials which you take if you feel any
    >potential symptoms.
    >Thank you both for your time
    >Mike Collins
 
Old Oct 11th 2006, 5:10 am
  #9  
Grant Kinsley
Guest
 
Posts: n/a
Default Re: long term prophylactic use

On Tue, 10 Oct 2006 11:25:48 GMT, "mikeyc" <u27709@uwe> wrote:

    >Can any one help me?
    >I am going to do a year long project in South Africa and i am trying to
    >decide what to do about anti malarials, all the reading says take them, wear
    >long sleves etc. However, i have come accross people and articles that say
    >long term exposure to these drugs can cause liver and kidney damage, if any
    >one can offer me any guidence on this i would be very appreciative.
    >Mike Collins


Doxycycline is certainly a good choice for long-term use. It's been
well tested over time, especially in long term use. It's cheap
(something the other anti-malarials aren't).

The disadavantages are: can't be taken at the same time as milk
products, but since it's once a day, most people do OK with that.
some people get a photosensitivity
reaction with Doxy, make sure you use sunscreen when on Doxy.

Ultimately, prophylaxis is good, but not 100% effective. The best
prevention is not getting bit, use a good DEET repellant, wear long
sleeves and long pants, use a mosquito net with pyrithin impregnation.

and remember sp. anoph. only bites at night, so those long pants and
shirts are extra important at night.

Grant Kinsley MD
 
Old Oct 11th 2006, 6:55 pm
  #10  
Marc Lurie
Guest
 
Posts: n/a
Default Re: long term prophylactic use

On Wed, 11 Oct 2006 17:10:00 GMT, grant kinsley
<[email protected]> wrote:

SNIP SNIP SNIP
    >and remember sp. anoph. only bites at night, so those long pants and
    >shirts are extra important at night.
    >Grant Kinsley MD

I understand that the anopheles is mostly active only for a few hours
each side of dusk and dawn.

From my own experience, relying on long trousers and long sleeved
shirts is pointless in many areas due to the heat. There is absolutely
no way you'd be able to wear long sleeved shirts in most countries
during the summer months or in the hot rain season.

DEET is the way to go, but be careful of the stuff because it eats
certain plastics. The front cover of my mobile phone was completely
chewed away by the DEET on my ear :-) It also tastes revolting :-(

Marc
 
Old Oct 12th 2006, 3:33 am
  #11  
Grant Kinsley
Guest
 
Posts: n/a
Default Re: long term prophylactic use

On Thu, 12 Oct 2006 08:55:30 +0200, Marc Lurie
<[email protected]> wrote:

    >On Wed, 11 Oct 2006 17:10:00 GMT, grant kinsley
    ><[email protected]> wrote:
    >SNIP SNIP SNIP
    >>and remember sp. anoph. only bites at night, so those long pants and
    >>shirts are extra important at night.
    >>Grant Kinsley MD
    >I understand that the anopheles is mostly active only for a few hours
    >each side of dusk and dawn.
    >From my own experience, relying on long trousers and long sleeved
    >shirts is pointless in many areas due to the heat. There is absolutely
    >no way you'd be able to wear long sleeved shirts in most countries
    >during the summer months or in the hot rain season.
    >DEET is the way to go, but be careful of the stuff because it eats
    >certain plastics. The front cover of my mobile phone was completely
    >chewed away by the DEET on my ear :-) It also tastes revolting :-(

hehe, my phone is the same, DEET certainly chews the plastic.

The only problem with DEET in the long run is it never seems to last
long enough twixt applications, and it is somewaht toxic at the high
concentrations needed.

pyrethin impregnated clothing is also another helpful option, leaving
less skin to cover with DEET.

As far as long clothes, good cotton or silk is quite nice, when I was
in Cambodia and Vietnam I wore long sleeves in 100% humidity at 40
degrees C and was as comfortable as shorts and short sleeves because I
stuck to cotton and silk (and the fact that shorts in SE Asia aren't
really considered proper)

And as far as the anoph. I think they are a threat from dusk to dawn,
not just around the two.

Best,
Grant
    >Marc
 
Old Oct 12th 2006, 10:51 pm
  #12  
Marc Lurie
Guest
 
Posts: n/a
Default Re: long term prophylactic use

Grant, you must be designed differently from me :-)

The THOUGHT of wearing silk in the heat is enough to make me sweat.

Light cotton is best for me, but my favourite (if possible) is a pair
of sandles, a pair of shorts, and nothing else (and a hat of course).

Cheers,
Marc

On Thu, 12 Oct 2006 15:33:47 GMT, grant kinsley
<[email protected]> wrote:
SNIP
    >As far as long clothes, good cotton or silk is quite nice, when I was
    >in Cambodia and Vietnam I wore long sleeves in 100% humidity at 40
    >degrees C and was as comfortable as shorts and short sleeves because I
    >stuck to cotton and silk
SNIP
 
Old Oct 13th 2006, 2:01 am
  #13  
Pat Anderson
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Posts: n/a
Default Re: long term prophylactic use

In message <[email protected]>, Marc Lurie
<[email protected]> writes
    >Grant, you must be designed differently from me :-)
    >The THOUGHT of wearing silk in the heat is enough to make me sweat.
    >Light cotton is best for me, but my favourite (if possible) is a pair
    >of sandles, a pair of shorts, and nothing else (and a hat of course).
    >Cheers,
    >Marc
    >On Thu, 12 Oct 2006 15:33:47 GMT, grant kinsley
    ><[email protected]> wrote:
    >SNIP
    >>As far as long clothes, good cotton or silk is quite nice, when I was
    >>in Cambodia and Vietnam I wore long sleeves in 100% humidity at 40
    >>degrees C and was as comfortable as shorts and short sleeves because I
    >>stuck to cotton and silk
    >SNIP
Grant would have perhaps found me an interesting case!
I went to Port Harcourt, Nigeria, for three years and was badly bitten,
swollen ankles, Cantharides beetle (blister beetle) bites which came up
and had to be burst, you name it it bit me! I always covered myself in
repellent and like Marc said, it was just too hot to cover up but I did
in Kenya, where I was for several more years. I never caught malaria
though but always took the recommended prophylactics for the area. I
spoke to long time residents on the Kenya coast who said they tend to
rely on "the cure" if they suspect they may be coming down with malaria
and also take anti malarials during the rainy season. It`s a nasty
thing to contract and imperative to take precautions and wear socks (I
had to as I was bitten walking through grass) and long trousers and
long sleeves from dusk.
Pat
--
Pat Anderson
 
Old Oct 13th 2006, 2:41 am
  #14  
Liz Leyden
Guest
 
Posts: n/a
Default Re: long term prophylactic use

In message <[email protected]>
Marc Lurie <[email protected]> wrote:

    > Grant, you must be designed differently from me :-)
    >
    > The THOUGHT of wearing silk in the heat is enough to make me sweat.
I've heard other people say this, but I find it cool in summer, warm
layered in winter, but the hand-washing is a pain!
    >
    > Light cotton is best for me, but my favourite (if possible) is a pair
    > of sandles, a pair of shorts, and nothing else (and a hat of course).
    >
I've found that loose long clothes (trousers or a dress) of light
material (like cheesecloth, a modern, more expensive, equivalent of
which is Swiss Cotton) is actually cooler, because it creates its own
breeze while I walk.

Slainte

Liz


--
http://www.v-liz.com - Kenya; Tanzania; Namibia; India; Galapagos
Photo Gallery:
http://www.betterphoto.com/gallery/g...emberID=165111
 
Old Oct 13th 2006, 3:59 am
  #15  
Pat Anderson
Guest
 
Posts: n/a
Default Re: long term prophylactic use

In message <[email protected]>, Liz Leyden
<[email protected]> writes
    >In message <[email protected]>
    > Marc Lurie <[email protected]> wrote:
    >> Grant, you must be designed differently from me :-)
    >> The THOUGHT of wearing silk in the heat is enough to make me sweat.
    >I've heard other people say this, but I find it cool in summer, warm
    >layered in winter, but the hand-washing is a pain!
    >> Light cotton is best for me, but my favourite (if possible) is a pair
    >> of sandles, a pair of shorts, and nothing else (and a hat of course).
    >I've found that loose long clothes (trousers or a dress) of light
    >material (like cheesecloth, a modern, more expensive, equivalent of
    >which is Swiss Cotton) is actually cooler, because it creates its own
    >breeze while I walk.
    >Slainte
    >Liz
Liz,
interesting! I`m OK during the day but at night I have to spray legs
and arms. I have got some lightweight, loose trousers which are great
for Kenya, they can be dressed up with a nice top. I used to wear short
dresses and have bare legs but soon found that was a mistake, I`m a
walking disaster as far as the mozzies are concerned! The wonder is I
never got malaria!
Pat.
--
Pat Anderson
 

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