Malaria Medication For Laos

[meadish_sweetball]

A friend is going into the less travelled parts of Laos and is going to do jungle treks. She was told by her doctor that the best option for malaria medication is Malarone.

However, it is rather expensive in Sweden (about 120 baht for one daily dose), so she wonders if she would be able to buy some at a better price in Thailand instead.

Does anybody know? Thank you in advance.

[Sheryl]

A friend is going into the less travelled parts of Laos and is going to do jungle treks. She was told by her doctor that the best option for malaria medication is Malarone.

However, it is rather expensive in Sweden (about 120 baht for one daily dose), so she wonders if she would be able to buy some at a better price in Thailand instead.

Does anybody know? Thank you in advance.

Wrong advice altogether for this part of the world, the strain of falciparum malaria found in Burma, Thailand, Laos, Cambodia is resistant to it. (Would be correct advice for most African countries, tho).

Malaria here must be treated by an artemisin derivative (oral form: artesunate). This is not approbved for prophylactic use.

For this part of the world, the best advise is no prophylaxsis, plenty of insect repellent/long sleeves and stay under an impregnated bednet once it gets dark.

At the first sign of fever afterwards, get prompt medical care, preferrably by someone familiar with the treatment of this strain of malaria. Actually one of the biggest problems is if one comes down with it once back in the west, as doctors will often treat with drugs to which the strains here are resistant. Also, in some countries artseunate may be hard to come by. If she really thinks she has been exposed -- i.e. spent the night in a known malarious arae -- might not be a bad idea to bring a course of treatment back home with her.

Her risk will be a whole lot less if the treks are day treks without overnighting in the jungle. The mosquito vector only bites at night, and there is little transmission in towns. Also not all "jungle" is necessarily malarious. The local people are the best source of information on which places are and are not. (But don't skip the insect precautions in any event! Besides, they'll also protect from dengue).

[Prakanong2005]

GSK do not sell Malarone in Thailand - there is a policy of not selling it in country's where Malaria is endemic.

Closest place to get it is Singapore on a prescription.

I have heard its available for treatment in Cambodia but its not supplied by GSK.

Its given to us free at work if we are going to malarial area's - they do not give it to us for Thailand - I work for GSK.

There is alway doxcycline at one tab a day at 5THB a day or so.

Sheryl - are you sure its resistant to it in Thailand etc - I thought that was the whole point about Malarone. From the official website and I am sure they would not post this if not true as PR is very important in pharma right now

"There are four types of malaria. MALARONE is approved for the treatment and prevention of Plasmodium falciparum malaria in adults and children weighing at least 25 lbs."

I will ask the country medical director about this or my pal a science writer who is working on our malaria vaccine project to double check

If you are really keen you could read the Clinical Trial data that we publish now for studies 6 months after LSLV

http://ctr.gsk.co.uk/Summary/atovaquone_pr...l/studylist.asp

Edited June 12, 2006 by Prakanong2005

[Sheryl]

There's nothing wrong with Malarone per se and is effective for prevention of malaria in areas with chloroquine resistance, which accounts for most of the world's malarial areas. It is not as far as I know effective in areas with chloroquine, mefloquine and quinine resistance (i.e. Cambodia, Laos, Burma and parts of Thailand bordering therein).

It is not approved by the Ministry of Health for any type of use in Cambodia. (Which of course doesn't mean you can't buy it....all sorts of odd things pop up in the pharmacies there, from all over the world, real and counterfeit).

"The use of artemisinin-based combination therapy (ACT) was pioneered in the Region early 1990s in response to the spread of malaria drug resistance. Currently, ACT is established as a first-line therapy in Cambodia and Viet Nam. The introduction of ACT is under way in the Lao People’s Democratic Republic and is under consideration in Malaysia and in several Pacific island countries and areas including Papua New Guinea, Solomon Islands and Vanuatu. ACT is the second-line drug in China and the Philippines."-- from WHO Pacific Region website

I'm surprised to note on the website you listed that a clinical trial of Malarone is underway in Thailand, would be curious to know in what part of Thailand and (when available) the results. Hard to imagine that the multi-multi-multi resistant strains (i.e. border region) would respond. Even if it did, unlikely to be approved due to long half life (whioch leads to very rapid resistance in endemic araes, that's the mistake that was made with mefloquine).

Doxycycline would provide some protection, true. If it were me, I'd just take care not to be after dark in an endemic area, use repellent & a net. I worked for 6 years right in the worst malarial part of the Thai-Cambodian border, treating people with severe malaria daily, and neither I nor anyone else working there took prophylaxis or got malaria -- but we slept back in the town. The mosquitos obey the rules re nighttime biting. They also don't stray that far from their preferred breeding grounds...a difference of 5 km along the border separated areas with hyper-endemicity from places with virtually no transmission. (I'm referring here to the mosquito vector for malaria common in Cambodia and Thai/Lao areas bordering it...may not apply to other mosquito vectors!) The local people usually know well which spots have transmission and which don't.

Back to OP -- if your friend does decide to take any dort of prophylaxis, be sure she knows that it is unsafe in pregnancy and reads up on the side effects (especially if she's going to take these for long).

GSK do not sell Malarone in Thailand - there is a policy of not selling it in country's where Malaria is endemic.

Closest place to get it is Singapore on a prescription.

I have heard its available for treatment in Cambodia but its not supplied by GSK.

Its given to us free at work if we are going to malarial area's - they do not give it to us for Thailand - I work for GSK.

There is alway doxcycline at one tab a day at 5THB a day or so.

Sheryl - are you sure its resistant to it in Thailand etc - I thought that was the whole point about Malarone. From the official website and I am sure they would not post this if not true as PR is very important in pharma right now

"There are four types of malaria. MALARONE is approved for the treatment and prevention of Plasmodium falciparum malaria in adults and children weighing at least 25 lbs."

I will ask the country medical director about this or my pal a science writer who is working on our malaria vaccine project to double check

If you are really keen you could read the Clinical Trial data that we publish now for studies 6 months after LSLV

http://ctr.gsk.co.uk/Summary/atovaquone_pr...l/studylist.asp

[Prakanong2005]

I am pretty sure the trial is over and if you click on the link it gives results - ie it was 100% effective in this trial but with AE's and one SAE.

"Atovaquone/proguanil was 100% effective (PP population) for treating acute, uncomplicated P. falciparum malaria with no recrudescence reported during the entire 28-day follow-up period. Furthermore, the elimination of P. falciparum parasitemia was accompanied by resolution of the clinical signs and symptoms of malaria. Adverse events were reported in 66 subjects, the most frequent being dyspepsia, upper respiratory tract infection and vomiting. The only serious adverse event, hypotension, was reported in one subject. No deaths were reported."

The results have to be posted withing 6 months of LSLV (Last Subject Last Visit) according to the agreement with the New York Attorney General on posting clinical trial results.

I know its not licensed in Cambodia but we had heard of it being avail there for treatment.

There is a dual strategy for licencing for both treatment and prophylactic use - some countries have one or the other or both or none

The last list I saw of country availability was at least 3 years old and its not an area in which I work.

AFAIK they are not trialling the Malaria vaccine in Thailand but the Dengue one is well underway.

[Sheryl]

Thanks. One more question -- which is not given on the website -- do you know (or can yuo find out) where the trial was conducted and where most of the patients were from? Because multi-drug resistance in Thailand does vary a bit by region.

I know we're getting off thread here -- but how far along is "far along" for the dengue vaccine trials? An effective dengue vaccine would really reduce child mortality in Cambodia. (Not to mention save a lot of farang suffering!)

I am pretty sure the trial is over and if you click on the link it gives results - ie it was 100% effective in this trial but with AE's and one SAE.

"Atovaquone/proguanil was 100% effective (PP population) for treating acute, uncomplicated P. falciparum malaria with no recrudescence reported during the entire 28-day follow-up period. Furthermore, the elimination of P. falciparum parasitemia was accompanied by resolution of the clinical signs and symptoms of malaria. Adverse events were reported in 66 subjects, the most frequent being dyspepsia, upper respiratory tract infection and vomiting. The only serious adverse event, hypotension, was reported in one subject. No deaths were reported."

The results have to be posted withing 6 months of LSLV (Last Subject Last Visit) according to the agreement with the New York Attorney General on posting clinical trial results.

I know its not licensed in Cambodia but we had heard of it being avail there for treatment.

There is a dual strategy for licencing for both treatment and prophylactic use - some countries have one or the other or both or none

The last list I saw of country availability was at least 3 years old and its not an area in which I work.

AFAIK they are not trialling the Malaria vaccine in Thailand but the Dengue one is well underway.

[Sheryl]

P.S. Forgot to mention that the commercially marketed MoH approved malaria treatment in Cambodia is registered under the name Malarine - so many folk might readily confuse it with Malarone.

Malarine is artesunate + mefloquinine. Marketed at a subsidized price by an NGO which also markets a self-test kit called Malucheck or something like it...the idea is you buy the test kit, if test positive, buy the treatment (sold as single treatment sets, designed for self-treatment and diagnosis).

OP - if your friend will pass through Cambodia, worth picking up one of each & keeping on hand, costs just a few dollars. Can develop malaria for up to 30 days after exposure.

[Prakanong2005]

Sheryl

See you PM - some stuff I can not post on a public board!

I will check the Dengue stuff for you and try to get some links - I was at a very interesting presentation for this in early May.

I know about "Malarine" and you are right some people do mistake this and this may be the source of rumours Malarone is availa in Cambodia

[cruciate]

In fact, malaria risk in South East Asia is much lower than in Africa. So the antimalarial prophylaxis is not universally recommended. Some authorities prefers stand-by drug to prophylaxis. Although traveler should have basic knowledge about malaria and aware the signs and symptoms of malaria. And whenever you get fever while or during traveling in the malaria risk area, you should have your blood checked for malaria.

[sabaijai]

Antimalarial drugs must be used with care. For more information about malaria in Thailand, see Mahidol University's FAQ about malaria in Thailand

What is the recommended antimalarial prophylaxis in Thailand?

Malaria chemoprophylaxis is not recommended in Thailand. Malaria, in Thailand, is the multidrug resistance strain. So no drugs can protect you against malaria. More over you may have unpleasant side effect from the drug. Antimalarial prophylaxis can be used in specific situation only. Counseling with qualified medical doctor is recommended in this issue. --Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok

[sabaijai]

I know we're getting off thread here -- but how far along is "far along" for the dengue vaccine trials?

The US army, in cooperation with the Royal Thai Army, has been conducting dengue research in Kamphaeng Phet under the auspices of AFRIMS for many years. I'm on the directory council for Rajabhat Univ KP, and hear bits and pieces on the research now and then. An American nurse working at the centre told me that trials of a dengue vaccine over the last three years show a lot of promise.

Title of the Study: A Phase I/II Trial of a Tetravalent Live Attenuated Dengue Vaccine in Flavivirus Antibody Naive Children

Principal Investigators: Stephen J. Thomas, M.D., MAJ, Medical Corps, USAMC-AFRIMS; Sriluck Simasathien M.D., Infectious Disease Consultant, Department of Pediatrics, Pramongkutklao Hospital, Bangkok

Location: Watsamiannaree School and Phramongkutklao Hospital, Bangkok

Collaborating Institutions: Department of Pediatrics, Phramongkutklao Hospital; the Thai Ministry of Public Health (MOPH); U.S. Army Medical Materiel Development Activity (USAMMDA); the Walter Reed Army Institute of Research (WRAIR); GlaxoSmithKline Biological (GSK Bio); Office of the Surgeon General of the Army, Department of Defense (DoD).

Description: Phase I/II, opened-label dengue vaccine trial in Thai children enrolled to receive two doses of dengue vaccine.

Status of the Study: The study ended in May 2004. Immunogenicity testing on-going. Data to be presented at World Health Organization (WHO) meeting, in Bangkok in October 2004.

Title of the study: A Phase I/II Trial of Tetravalent Live Attenuated Dengue Vaccine in Flavivirus Antibody Na?ve Infants

Principal Investigators: Mammen P. Mammen Jr., M.D., LTC, Medical Corps, Chief , Department of Virology, USAMC-AFRIMS; Sriluck Simasathien , M.D., Infectious Disease Consultant, Department of Pediatrics, Pramongkutklao Hospital, Bangkok, Thailand

Location: Phramongkutklao Hospital, Bangkok

Collaborating Institutions: Department of Pediatrics, Phramongkutklao Hospital; the Thai Ministry of Public Health (MOPH); U.S. Army Medical Materiel Development Activity (USAMMDA); the Walter Reed Army Institute of Research (WRAIR); GlaxoSmithKline Biological (GSK Bio); Office of the Surgeon General of the Army, Department of Defense (DoD).

Description: Phase I/II randomized, open-blinded, controlled study of dengue vaccine in infants.

Status: On-going

The successful vaccine licensed for use against Japanese encephalitis was developed at AFRIMS in Kamphaeng Phet as well.

AFRIMS is also evaluating several new malarial vaccine candidates both in the laboratory and in the field.

AFRIMS recently completed testing of a blood-stage vaccine in 1350 volunteers at a remote field site near the Myanmar (Burmese) border. Other efforts have focused on field trials of new anti-malarial compounds, and evaluation and testing of new mosquito repellents, insecticides and barriers to reduce human/mosquito contact. A study to evaluate the antibiotic Azithromycin as a malaria prophylactic is currently underway in Kanchanaburi province.

[ace]

I would also be interested in any advice on anti-malarial (preventative) for Vietnam, specifically the Mekong delta area - where I am hoping to travel in a couple of months time. I'm inclined not to take the pills and stuff if I can as the side effects look pretty nasty!

[RoryT]

I think the best thing to do in all cases is to talk to your doctor. There's lots of misinformation and many rumours out there in the general public and you have no way of knowing how sound people's advice is. Mine told me that for the whole of south-east Asia doxycycline and Malarone were the best options.

I went for Malarone because doxycycline can increase your sensitivity to sunlight, but Malarone is very expensive. As far as I know they are both effective all across the region - I seem to recall that they are two of the drugs where there is no resistence - but I don't know for sure- as I said, it's best to ask a doctor before taking anything.

It does seem stupid to me not taking anything at all, most of the drugs available don't have severe side effects (Malarone has very few, for instance) and the benefits are clear for both yourself (much greater chance of not getting malaria) and others (not getting malaria means that your blood won't be infected and malaria can't be passed on to others from a mosquito biting you - i.e. it stops the spread of the disease).

That said, some people certainly aren't suitable for certain drugs (pregnant women, children, people with kidney disease, people with other health problems etc. etc.) so it's ALWAYS best to ask your doctor individually.

I would guess Ace has been looking at the effects of Mefloquine (Lariam) which are severe, but as far as I know doxycycline and Malarone are both preferred to it.

A few links can be found at the end of this Wikipedia article: http://en.wikipedia.org/wiki/Malaria_prophylaxis#References . The article itself is very comprehenesive but there's always the risk with Wikipedia that it's not completely accurate. The government advice is worth a look - but like I said, speak to a doctor, that's the best idea and something you should always do whenever there's uncertainty like this.

Edited May 11, 2007 by RoryT

[RoryT]

There's nothing wrong with Malarone per se and is effective for prevention of malaria in areas with chloroquine resistance, which accounts for most of the world's malarial areas. It is not as far as I know effective in areas with chloroquine, mefloquine and quinine resistance (i.e. Cambodia, Laos, Burma and parts of Thailand bordering therein).

I think Malarone, doxycycline and mefloquine (Lariam) are actually among the only drugs that DO work in areas of multiple resistance.

-

Also, with regard to my post above - the side effects of mefloquine (Lariam) be extremely severe, but that's very rare. More common are less severe side effects like nightmares, but most people who use the drug are fine. Anyone thinking of using it should ask their doctor about it.

Edited May 11, 2007 by RoryT

[Lickey]

Acording to my UK doctor, im living in a high risk area, after having Doxy for 2 months and then being assured by a local doc that there is no risk here, i gave them up and used prevention rather than cure, without tablets, have a read through this TV site, hope it will help you, good luck, Lickey,

http://www.thaivisa.com/forum/index.php?sh...uito+reppellant

[sabaijai]

Since the original post question is over a year old, and meadish sweetball has long since returned from his Laos trip, I'm closing this thread.