Anti-malarials

One of the requirements for Daniel to go to Africa and join the Doulos in ten days' time is that he takes anti-malarial tablets. He had an email saying that the medical advisor recommends either mefloquine or doxycycline as the drugs to take. The older ones aren't very effective in Africa as the malaria parasites have built up resistance (or so we gather). The newest drug, Malarone, is recommended too, but expensive.

Dan asked about these when he went to the hospital for his yellow fever and booster vaccinations last week, and they said the tablets can just be bought at a pharmacy. Online research suggested that they were supposed to be prescription-only tablets, and today Dan commented that some of them had to be taken two weeks before visiting a malaria-risk country.

So I did some more research and learned that malarone was no use as it's only been trialled for 28 days, and mefloquine isn't possible either, since that has to be started 3-4 weeks before going! What's more, mefloquine sounds like a horrible drug with all sorts of side effects: not only physical, but it can lead to insomnia, hallucinations and depression. Under its brand name Larium, it's even been reported as responsible for killings and suicides. Moreover 20% of people who start to take it decide it's not appropriate for them and have to change to a different drug... which seems rather pointless to me!

So doxycycline appeared to be the best choice. It's not supposed to be taken by anyone pregnant or breast-feeding, but that's obviously not a problem for Dan! It can lead to extra sun-sensitivity, particularly when taken with alcohol, but he doesn't drink, and certainly won't be on the Doulos. It can lead to heartburn if taken last thing at night, or stomach upsets if taken first thing in the morning.. so he'd have to take it after a meal, and with plenty of water. Moreover it's daily rather than weekly, which is much easier to remember.

But would the pharmany have this drug, I wondered. And would they sell it to me without a prescription?

I needn't have worried. This is Cyprus... as soon as I showed the pharmacist the chemical name, he went to a little cupboard and pulled out a box with brand name Vibramycin, and the correct ingredient. He told me it was an antibiotic and that all antibiotics of this sort are anti-malarial. I asked when Dan should start taking it, and he said a day or two before travelling. I said he would be away for two months, so he sold me eight boxes, each of which had eight tablets in. The cost was about ten pounds in all (roughly $20 US) which seemed very reasonable - I had thought it might have been considerably more.

A little further research revealed that this particular brand is indeed a recommended anti-malarial in the UK.

Of course two months on an antibiotic isn't exactly great health-wise, but it sounds better than the alternative suggestion. Dan knows he must try and eat as much yogurt as he can to restore healthy bacteria in his gut, but then it's always a good idea to eat locally produced yogurt in any new country, to accustom oneself to local beneficial bacteria.