Several months ago, I wrote a post about my doctor suggesting that I skip taking an anti-malaria drug. I was going on a trip to several countries in South Africa where malaria is a risk. My doctor advised the side effects of the antimalarial drug were worse than getting the disease. I didn’t know the name of the drug my doctor was referring to and I hadn’t done any research, so I accepted her suggestion without asking any questions.
I wrote that blog in reaction to an op-ed piece condemning melfoquine, brand name Lariam, which has been in the news because of the extreme and potentially long-lasting side effects — in extreme cases: neurological issues, hallucinations, violence to self and others. Like many people, I leaped to the conclusion that antimalarial drugs are dangerous. I also assumed that modern medicine can cure malaria — 2 foolish assumptions.
Lariam is still listed on the CDC website for use by travelers in South Africa despite the fact that the US Army no longer uses or recommends it. For many years Lariam has been the “drug of choice” for the US Army, but now the Surgeon General is warning that the neurological side effects of Lariam are highly similar to PTSD, leading to misdiagnosis and mistreatment.
A good friend sent the following eMail:
Dear Su,
I read with great interest the piece on malaria meds, as we have taken them on numerous occasions over the years, thankfully without any ill effects. But I am dumbfounded that a doctor would advise risking malaria when there are a number of preventatives available besides the one you mention in this article; malaria can be a life-long disease and is nothing to fool around with. But more importantly, there are different drugs that are effective in different parts of the world; it’s not a situation of “one drug solves all.”
On one of our recent trip’s, one of the options available to us was the antibiotic doxycycline. While it has its own side effects, most notably sun-sensitivity, it can be used by people who are afraid to take other anti-malarial meds or who can’t take them because of drug interactions. It was said to be effective against the strain of malaria found where we were going. It is also cheap, an attribute which many of the other malaria-specific drugs do not have. I think the message of your piece about not blindly following an unknown doctor’s advice (or even a known doctor’s advice!) is critical. It’s incumbent upon us to do the necessary due diligence on any drugs that are prescribed, but I hope this article is not taken as a “avoid malaria drugs at all costs” warning.
My friend makes several valid points here. First, as with most medical conditions there are several drug options in prevention and treatment.
Second, malaria is not a disease to take lightly. It can come on in 7 days or take several months (or longer) to manifest. Because our trip was a little longer than 2 weeks, we could have become ill in Africa — a possibility that we didn’t consider. Alternatively, American doctors see malaria so infrequently that it could easily be misdiagnosed with a possible fatal delay of care. Once the symptoms present it should be treated quickly and “radically” — the term medical sites use. The most serious type of malaria causes breathing problems, seizures, organ failure and severe anemia. After being cured, parasitic eggs can live in the liver for a period of time and then hatch causing a recurrence of malaria.
This is not a disease to fool around with. In defense of my doctor, she asked several probing questions about how far outside any city we thought we would be, for what period of time, during what season before making her recommendation.
My friend was right, even when the doctor is giving good advice, my health is my responsibility.
For more information, see our Malaria Fast Facts and Antimalarial Drugs and Side Effects.
