Anti-malaria medication for travelers to interior of Sabah

While doing my daily work today in the clinic, a guy from Canada came to see me regarding prophylaxis (preventive) medication for malaria while traveling here in Sabah. He planned to join a volunteer work that involved in providing ‘gravity feed water’ in few villages in the interior of Sabah. It occurred to me that this is also a good way to provide you the information about taking anti-malaria medication before coming to Sabah, especially if you plan to go into the virgin rain forest here.

In my medical school days, there are only few numbers of mediation that you need for malaria prevention. However, as the time goes by, there have been known that some species of malaria are resistant to the earlier treatment and medication.

I look into this website, International Association For Medical Assistance To Travelers (IAMAT), and found out specific guidelines on malaria prevention to travelers who wants to travel to anywhere around the world. Specifically, I look for ‘malaria’ and ‘Sabah, Malaysia’.

I found out that I have their “World Malaria Risk Chart”. I can’t remember where I got it, but it is the most relevant information that I can share with you. The leaflet was printed as at March 15, 2005. I don’t think that there are a lot of new anti-malaria medication for the past two years.

So, what are their recommendation?

Sabah is considered a place with high incidence of choloroquine-resistant and/or multi-drug resistant Plasmodium faciparum in Malaysia. You need to follow ONE of the following suppressive medication regimes:

FOLLOW A LARIAM (MEFLOQUINE HYDROCHOLORIDE) REGIMEN:

LariamTake one tablet of LARIAM 250mg ONCE a week. Start one week before entering the malarious area, continue weekly during your stay and continue for four weeks after leaving. (Lariam should not be taken by persons suffering from cardiac diseases, liver or kidney disorders, epilepsy, psychiatric disorders, pregnant women and children under 30 lbs/15 kg in weight.)

FOLLOW A MALARONE (ATORVAQUONE + PROGUANIL) REGIMEN

MalaroneTake ONE tablet daily (250mg Atorvaquone +100mg Proguanil). Start 1 to 2 days before entering the malarious area, continue daily during your stay, and continue for 7 days after leaving. MALARONE should be taken at the same time every day with food or milk.

FOLLOW A DOXYCYCLINE (VIBRAMYCIN) REGIMEN

Take ONE tablet daily of 100mg Doxycycline (Vibramycin). Start one day before entering malarious area, continue daily during your stay, and continue for four weeks after leaving.

DoxycyclineWhen taking Doxycycline avoid exposure to direct sunlight and use sun screen with protection against long range ultraviolet radiation (UVA) to minimize risk of photosensitive reaction. Drink large amounts of water to avoid esophageal and stomach irritation.

Doxycycline should not be taken by persons with known intolerance to tetracyclines, pregnant women and children under eight years of age.

ANTI-MALARIAL REGIMEN FOR PERSONS WHO CANNOT FOLLOW ONE OF THE ABOVE REGIMEN

ChloroquineTake Chloroquine (Aralen) in weekly doses of 500mg (300mg base). Start one week before entering malarious area, continue weekly during your stay and continue for four weeks after leaving. It is imperative to use a mosquito bed net to avoid the bite of the nocturnal Anopheles mosquito. Use repellents and insecticides.

Persons following a Chloroquine regimen must be aware these drugs are much less effective than Lariam, Malarone or Doxycycline. They must seek immediate medical attention in case of flu-like symptoms – fever, headache, nausea, general malaise – appearing about seven days or later after entering malarious area.

Persons traveling to or working in remote areas where medical attention cannot be sought within 24 hours should consult with a specialist before leaving their home country for advice on possible self-treatment regimen in case of a malaria breakthrough attack.

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