Sincerely,

M. Lance Phillips

PAC Chairman and Board Member

Dallas Safari Club

I READ WITH INTEREST YOUR COMMENTS ON REACTIONS FROM ANTI MALARIA MEDICATION. REACTIONS TO THIS GROUP OF MEDICATIONS HAS ALWAYS BEEN AN ISSUE. I THINK THE MOST IMPORTANT THING A HUNTER OR TOURIST CAN DO WHEN ONE VISITS AREAS THAT ARE MALARIA INFESTED IS PREVENTION. IN ORDER FOR ONE TO GET MALARIA THEY MUST BE BITTEN BY A MALARIA INFECTED MOSQITO. THEREFORE ALL EFFORTS NOT TO BE BITTEN MUST BE TAKEN. SOME OF THESE INCLUDE REGULAR USE OF REPELENTS ,WEARING OF LONG SLEEVED SHIRTS,AND LONG PANTS , AVOIDANCE OF FRAGRANCES, TAKING LARGE DOSES OF B COMPLEX VITAMINS, ETC..

OBVIOUSLY, THIS ALONE IS NOT ENOUGH, BUT THE RISKS OF ANTI MALARIA MEDICATION ARE THERE. WHAT I HAVE DONE ON MY LAST COUPLE OF AFRICA TRIPS IS TAKE DOXYCYCLINE, WHICH IS AN ANTIBIOTIC WITH MINIMAL SIDE EFFECTS ,ONE BEING ENCHANCED REACTION TO SUN EXPOSURE, SO ITS IMPORTANT TO USE AN SPF SUN BLOCK OF AT LEAST 30 , AND APPLIED REGULARLY. I AM NOT ADVISING ANYONE TO DO THIS WITHOUT FIRST CONSULTING THEIR DOCTOR OR A TROPICAL DISEASE EXPERT. THIS IS PERSONAL EXPERIENCE THAT HAS WORKED FOR ME.

I HOPE YOU ARE ALL WELL BY NOW. BEST REGARDS FROM NEW YORK.

MARINOS A. PETRATOS, M.D.

My wife and I both took Malarone: The PH & his wife ask how we were sleeping? I told them that my sleeping was less than sound and i was having really wacky dreams. They ask if i was taking malarone.. seems most of the hunters taking it had the same problem. sure enough when i returned home and stopped taking it.. the wacky dreams stopped.

thats it..

thanks

sam mills

The Larium dreams began immediately and were not terrible depression as I had been warned, but scarey enough that I only tried it three weeks. The third time, I had a single glass of Amarula on the night of taking it, about 10 hours later, and had a pretty wild hallucination that night. Gave up the Larium, not the Amarula! Took mefloquin for four months. No side effects til my hair started falling out, first a few strands more than usual in the brush, then gobs at a time. When I stopped, about two weeks later the hair falling decreased, then eventually stopped and regrew. So I was left with Fansidar, which made me a bit nauseous if taken on a not full stomach, and eventually, I think I had been on it about 2 months or so, I got malaria. Now there is a chance I missed a small window and got bit by mossies during it, but many say it is not totally effective. After resolving fine with Quinine, I figured no prophylactics for me for the remainder of my long stay, I was just careful re mossies and carried more quinine with me.

I apologize for not communicating sooner, after I read your initial story on Anti-Malarials.

On our trip to CAR last June, Arlene and I were both taking Malarone, which we started before our departure from the U.S. All was fine until we finally reached Alain Lefol's camp in the rain forest, after being delayed enroute for close to five stays (staying and/or stopping in such lovely cities as N'Djamena, Brazzaville, Douala and Bangui).

On our first day at Alain's camp I was fine until after lunch, when I developed rapid heartbeat, lightheadedness and some dizziness. I felt so crummy that I stayed in the hut for the rest of the afternoon and night - where I was visited by a native "doctor" from the village (the first time that I've ever been attended to by a doctor in bare feet!) Early the next morning I felt better and talked to my Wyoming doctor by sat phone. Since I was already taking a prescription drug for atrial fibrillation, he adjusted my dosage, and the problem resolved itself. I hunted without incident for the rest of the trip (getting a nice Bongo in the process).

Accordingly, whether the Malarone precipitated my heart arrthymia, or I was merely having a periodic bout of atrial fibrillation, we'll never know. I am going back to read the literature on Malarone and see whether or not it's counter-indicated for people with existing heart rhythm problems and lists heart rhythm problems as a potential side effect.

I hope all is going well. Best regards.

Bob Hanson

P.S. I was armed with my Medjet Assist insurance in case I had needed evacuation.

In all of the years (20) at least, my clients have been taking malaria medication, in particular Larium/Mefloquine I have told every one the following:

1. Only take the medication with breakfast in the morning.

2. Eat two pieces of bread preferable with peanut butter with breakfast prior to taking the pill.

3. Immediately after breakfast drink three glasses of water

4. Drink lots of water all day the day you take the pill.

5. Do not take the pill after noon

6. Do not drink alcohol the day you take the pill

7. Never never take the pill after 12 noon.

I have only had two clients have reactions to the medication and they had a tendency to have more than a few toots every night and afternoon.

My doctor, was born and raised in the Congo to medical missionary parents. He said all malaria medication should never be taken on a empty stomached

preferable bread taken to absorb the medication.

Just thought you would find this interesting. It sure has worked for my clients.

Bev

J/B Adventures & Safaris

The May 2006 issue asks for personal experiences with the use of “Larium”. This drug was prescribed by our local health department for my first safari in South Africa in 1989 which at that time was still under apartheid rule.

As the trip wound down I began having nauseous and dizzy spells and having weird day dreams. We had to travel via Kenya and Amdsterdam, taking nearly two days to get to Seattle. My son took the same pill and did not have any problem.

On the plane I had spells of chills and fever, often thirty minutes apart, twenty four hours a day. I visited my doctor immediately who was at a loss to diagnose the problem. He took blood samples and sent to a local lab. Nothing was learned. During the next week I was so sick I needed to get better to die and really didn’t care if I did.

During the nextweek 18 blood samples were taken, sent to Univ of Washington hospital, Mayo clinic and National Diagnostic center in Atlanta. Nothing was learned. The only food that didn’t make me vomit was canned peaches. My normal weight is around 160 and I lost 25 pounds within two weeks.

I had such bad chills during the night I nearly shook apart and would get up to take a hot shower. An hour later I had such a high fever I thought my body would break out in flames so I got up and took a cold shower. I suffered this way for at least six weeks before I began to improve. I am a polio survivor so sickness is not a novelty but polio was better than a Larium reaction.

I lost nearly two months work during the ordeal. After I recovered I was weak for a long time but am now no worse for wear.

Six months ago I read an article concerning problems caused by Larium that did not come to light for years. Some persons had suicidal tendencies and 10% of the persons taking Larium had severe reactions very similar to mine.

On our next 4 trips to the Dark Continent, we were prescribed Dioxycycline and had no problem. Needless to say, after the first experience, my wife thought I was crazy to go again because she knew that I would surely die hunting in that “awful place.”

I hope all is now well with you. “The Hunting Report” continues to furnish the best information for hunters. Keep up the good work. I look forward to seeing you again at SCI convention next year. Cheers.

Dick Vander Yacht

Blaine, WA

You may already know that Malaria prophylaxes are not 100% effective. They are more like 90-95%, which is significant. That means you can be taking your pills correctly and still get Malaria. When you are deploying a military unit, that means 5-10% of a unit may get Malaria and require medevac - a significant planning consideration. If you are an individual traveler, I strongly recommend a MedJetAssist type of insurance - your life may literally depend on it. Obviously you are no stranger to the importance of this, but the average guy might not be aware that his Malaria prophy might not work. I have in fact had troops who did get Malaria despite their prophy. Two of them died as a result, and one who had cerebral Malaria came within a hair's breadth of dying. Only immediate medevac to Landstuhl Germany saved him. I'm sure you have read of the Europeans who came to Africa prior to the discovery of Quinine. One Scottish regiment deployed 225 men to Sierra Leone and a year later 223 of them were dead. Malaria was and is a killer. There are lots of interesting little cemetaries in former British and French colonies to prove it.

Regards,

Rick

First, your publication just gets more informative with each issue. It's a must for any serious hunter and anyone "in the business". Thanks for your efforts.

I felt I should comment on the Malaria Medication issue. I've spent months in Africa with clients every year since the early 90's and have seen lot's of reactions to Larium. The same reactions expressed by your readers. However, I recently had a doctor ask me if those that reacted most radically were dark complected with brown eyes. This, as apposed to blue eyed blonds. Interesting question and if memory serves me, they were.

I haven't personally experienced any side effects from Larum or Malarone. Most of my clients now use Malarone. I did experience swelling of hands and ankles the year I took Dioxycycline, in addition to the sun sensitivity.

In July '01, I spent 5 days in intensive care in the Aga Khan Hospital, Dar es Salaam, Tanzania. Cerebral malaria can kill you and almost killed me. At the time, I thought I was bullet proof and invisible and didn't take any preventative. I was in the Selous. I've since gotten smarter, I hope. , If you are in a malarial area take some preventative.

Regards, -Russ-

I'M RESPONDING TO THE ARTICLE IN THE APRIL ISSUE ON MALARIA MEDICINES.

I HAVE BEEN USING A MALARIA MEDICINE CALLED MALAFOUQUIN(not sure about the spelling). I HAVE GONE TO ZIMBABWE ONCE IN 2001, TANZANIA TWICE , 2003 AND 2005 AND USED IT EACH TIME WITHOUT ANY SIDE EFFECTS. EACH OF THESE HUNTS WAS 21 DAYS. MY DOCTOR HAD HEARD ABOUT SOME SIDE EFFECTS FROM THE OTHER MEDICINES AND SUGGESTED THIS DID NOT HAVE THE ISSUES THE OTHERS DID.

I AM REGULARLY TAKING LIPITOR, A HIGH BLOOD PRESSURE MEDICINE CALLED DIOVAN, AND PLAVIX TO NAME A COUPLE.

THANKS GEORGE KISHIDA

Very interesting article on anti-malarials. We definitely need more info on this subject. On my trip to Africa in 2001 we took malarone and seemingly did fine. In fact my young cousin who went on the trip with us got confused and took a whole weeks dose of the med at one time (7 pills) instead of the recommended pill a day. He's still alive and kicking and walked for miles during the trip. I am a dental specialist in Jackson MS and know a little bit about different meds. There was great debate before our safari on which med to take and whether or not we even needed it. Our PH told us not to take it even though we were hunting in an area of South Africa where it was recommended (Timbavati preserve adjoining Kruger in the Northeast Transvaal). We decided not to take any chances and take one of the different meds which included: Larium, Doxycycline, Malarone, and the combination drugs which most Africans recommend which includes Chloroquine and another drug which I can't remember right now. I was told to take Larium by my personal physician and I declined due to hearing horror stories about side effects and also being prone to dreams and sleepwalking. In fact my PH was so against it he said he didn't want to hunt with us if we were taking it. My friend and physician Kyle Ball and also a frequent contributor to SCI magazine recommended Doxycycline. I decided against that also due to decreased melanin production and thus sunburn. I was strongly advised by a longtime missionary to Malawai to take the traditional African meds but I declined that also due to the potential for chloroquine resistant strains of malaria. I thought we had found the perfect choice in Malarone until I read your article. It was recommened as really the "ONLY" choice by a brilliant infectious disease specialist and travel Doctor in Jackson. I faxed him your article this morning and hopefully he will respond to you, me or both. Thanks for the article and keep us informed as you always do! Due to your article on your experience with injury in Africa we are definitely going to purchase Medjet insurance before our next trip. By the way we met in Biloxi last year at the sheep convention. Also the doctor's name who recommended malarone is Skip Nolan M.D.

Clarke Stewart D.M.D.

Note some people take Doxicyclene as the anti malarial. You are susceptible to reaction to sun burn when taking Doxicyclene. From our limited sample, all three anti Malarials were effective. Some folks still got malaria, not me; but these drugs are not 100 percent protection.

Paul K. Johnson, subscriber

Please be advised that there is yet a third possible drug to be used to prevent malaria and that is Doxycycline. That is a medication that I use when I travel to Africa. Doxycycline has very few side effects as long as one is not allergic to it. If taken with meals, it rarely causes any gastrointestinal upset. Prolonged sun exposure can cause a photosensitivity reaction. That can be avoided with the use of a heavy-duty sunscreen, which should be used in tropical areas anyway.

I have tried Malarone and did not care for the side effects, particularly a sensation dysphoria. On the other hand, my wife and many of my patients have tolerated Malarone without any significant problem.

I have prescribed Larium in the past, but no longer do so. Two of my patients developed severe hallucinations while taking Larium. As you can imagine, that could create a disastrous situation in the hunting field.

One of my patients recently returned from a year long tour of duty in Afghanistan. He tells me that the United States Army is currently issuing Doxycycline for malaria prophylaxis.

I am enclosing a copy of a publication that I receive regularly called The Medical Letter. There is an excellent discussion on page 100 regarding various medications used to prevent malaria as well as information regarding protecting oneself against mosquito bites. You may keep this copy of The Medical Letter as I have another.

I have also found the local County Health Department to be an invaluable resource when researching the issue of malaria prophylaxis. Most County Health Department’s have a continuously updated database from the World Health Organization listing recommended medications for malaria prophylaxis in various parts of the world. Any individual or any physician can contact their local County Health Department to receive such information.

I hope this information will be helpful to you. I very much enjoy your publication and look forward to receiving it every month.

Joseph H. Diehl, MD

I have taken Larium on two occasions (Africa safaris to Tanzania and Zimbabwe) for 10 weeks and 5 weeks, without noticing the oft-reported side-effects.

I do not doubt that some people DO have a troubling reaction to Larium. I was discussing my travel medications with two professional hunters (Jean Michel Latrive and Pierre Joncquerre) over our "sundowners" in the Selous Game Reserve. When I mentioned Larium, they both glanced at each other. Pierre shook his head and gravely said to me, "Bad. Very bad."

Even so, malaria is no joke. I was drilled in both ankles (through my socks!) by scores of mosquitos one evening while standing idle in the Selous, as my Cape buffalo carcass was being gutted, halved, and loaded into the Land Rover.

May I suggest, as a follow-up to your article, that you write an informative article on the importance of avoiding insect bites while on safari in malarial areas. Safari outfitters will provide netting for the hunting camp beds, but each hunter should pack his own bed netting for other situations. For example, I was troubled throughout the night by several mosquitos while over-nighting in a "one star" hotel in Kwekwe, Zimbabwe.

Hunters must bring their own mosquito repellant!! The types of repellent found in Africa are not as effective, in my judgment, as Deep Woods "Off" and similar American products. I much prefer using an aerosol can of mosquito repellant, because the spray can be applied more evenly than a liquid to clothing (socks, shirt cuffs, collars, caps) and skin. Some of the aerosol sprays are now manufactured and marketed as "odor free," which is probably a good thing for hunters. (Although I suppose that a nyati will still be able to smell the hunter's sweaty armpits and gastric reflux.)

Best wishes,

Harris Stuermer Anchorage Alaska

First and the easiest to explain is my use of Malarone. Simply stated, I can not sleep on the medication. Nothing helps. The problems continue for a couple of weeks after I stop.

Now for Larium. Personally, I have only taken it one time. This was several years ago on a 21 day hunt in Tanzania. However, my brother took it.

We spent several days in the Moyowasi. We did not experience any particular problems. We then moved to Maisai land. On the second day in Maisailand, we headed toward Lake Natron. About half way there, my brother announced he was not feeling well. I asked if he wanted to go back to camp. He insisted he was OK and that we should continue.

We got to the appropriate location and took off chasing wildebeest and watching the thousands of flamingos on the lake. My brother had decided to stay in the car. About 2 hours later, we returned. As soon as I looked at my brother, I knew he was in trouble. He was very pale. Quivering and throwing up uncontrollably. He had a severe headache.

It was something like 5 hours back to camp. Before we were even half way, I honestly thought my brother would die. I have NEVER seen anyone that sick. It crossed my mind that he might have had cerebral malaria. He was in real trouble.

When we got to camp, which was a very long way from Arusha, we discovered the radio was not working. I discussed this with the PH. We decided to try and spend the night at camp. We gave my brother some medication for people who actually have malaria. I also got him to drink a bit of Gatorade to help with dehydration.

The next day, we drove to a camp considerably closer to Arusha. My brother felt better but was not 100% or even close to it. I decided if he threw up even one more time, we were out of there. He threw up a couple of times. We headed back to Arusha.

To make a long story short, the doctors here in the US think it was all a reaction to Larium. Larry Shores

I received your report on anti-malaria medicines. I thought I would share a quick story. I was in Kenya in February on a missions trip with World Vision. My doctor put me on Mefloquine (which I believe is the generic version of Lariam) which I started taking one week before we left. I took my second dose the day we left home for Nairobi and until we got to Kenya I was a mess. Mel Toponce described it perfectly in your article. I felt just plain awful! For me it was mostly dizziness along with a few headaches and some pretty wild dreams. Not knowing what the problem was World Vision sent me to the Nairobi hospital after 4 days of this. The doctor there was shocked that I was on Mefloquine. He said they never prescribe that drug and referred to the problems the United States had in giving this drug to service men in Somalia in the 1990's. Many of them apparently experienced hallucinations, depression etc.

My wife and 6 others from our group took the same drug and never experienced any problems. We are scheduled for a hunting trip next year to South Africa and I will definitely be taking something different.

I enjoy the hunting report very much. Keep up the good work.

Doug Shelly

Having been through three solid weeks of no sleep and anxiety (for no reason), a couple years ago while hunting in South Africa, I fully agree with your assessment of Larium. It's a horrible drug...even if it does supposedly protect one from malaria. Last year, as I was preparing to leave for Botswana to hunt in the Okavango Delta, I told my local Wisconsin Doc, Dr. Tashjian, that I did not want to take Larium again unless I absolutely had to, (I described the problems that are spelled out in your Hunting Report article). Dr. Tashjian very calmly told me, "Well, Larium is a bad drug. Why don't I just put you on Doxycylcline?" (One of my favorite drugs). End result...I went to Botswana, took several coveted trophies, slept like a tired dog every night, had no hallucinations, no heart palpitations, NOTHING! It was great! As an added plus, whatever crud and germs I breathed in on the plane on the way over, never touched me as I was on a very strong antibiotic. One Doxycycline 100 mg per day worked fine. I didn't get malaria, nor did I develop a case of the stereotypical horrible hacking, wheezing, sneezing flu/ cold that I had on every single African trip prior to this last one. Let's face it...there are always going to be a certain number of really sick, as in ill, people on every jumbo or wide body jet. I happened to be on one of those horrible South African Air Airbus 380's that have been widely criticized worldwide, in business class. But after they slip you the carbo-infested 6 p.m. meal in NY or Atlanta and you drop off to sleep and they shut down the chillers AND the outside air intake...we are all breathing the same stale, sickness infested air. Long story short...if there is just one really sick individual on the plane who occasionally coughs, we ALL GET THE CRUD because the air is recirculated again and again and again! Unless of course, you are already on an antibiotic like Doxycycline for malaria.

Why not take something that does two things? Doxycycline prevents malaria and airplane crud at the same time. It also prevents you from developing debilitating upper respiratory problems should you be exposed to them by people on the ground, be it your PH, your trackers, an airport bell man, a camp cook, whatever!! Take Doxycycline and kill two birds with one stone. And...it's cheap!!!!! Plus, whatever you don't use on your trip can be used to knock out infections when you return home. There is no question.

Richard Sanders Prescott, WI

1°) Keep with Nivaquine, but

2°) Adapt dose to your weight, effort, fatigue, impended zone more or less dangerous

The dose is not the same for a little girl of 100 Pounds, keeping idle of for big hairy Dan CAUSEY exerting himself all day after elephants!!

3°) Keep away from the mosquitoes! It is simple, got damned! No bare arms, bare legs at night!

No long drinking sessions around campfire about virtues of such and such calibers.

No loose mosquito nets, watch about the absolute cleanliness of you feet (yes, yes, your feet).

Have boiled with the shower water. Citronelle Grass

Go to bed early.

If any sign occurs of malaria, you may use the same stuff, but remember!! Nothing better than good old Nivaquine up to 5 pills!!! Plus shots of “Quinimax“ intra venous, and in hospital as soon as possible, and watch out the usual mistake : it all begin like malaria. OK. Malaria treatment, no effect, blood sample analysis, nothing but it was sleeping sickness! Jacky BLACKLAWS died like that and many others! In any doubt : marrow analysis.

But for god sake : don’t get bitteN it is easy.

I think I can tell you that after sixty years of Safaris in Africa – Asia, and a great deal of travel hunting and soldiering, and I would like to ad this. We, the French and US Army are lucky enough to have the best Military Medical Corp in the world with possibly the British, why don’t you ask them what to do or don’t do?

Best regards

Marc PECHENART

I read the recent piece on malarial prophylaxis in the hunting report with great interest. I too have had very bad experiences with Lariam and will never take it again. Prior to one of many Zimbabwe trips in 1999, I had always taken chloroquine as prophylaxis on a number of lengthy sojourns in south Asia with no ill effects, and for Africa as well. The problem, as you probably know, is the proliferation of chloroquine-resistant strains of malaria, especially in Africa. My wife, two children and I all took Lariam in 1999 and two of the four of us had problems. My daughter and I both experienced dizziness, lack of appetite, and in my case, some blurry and double vision -- not exactly desirable in a dangerous-game situation! The theoretical advantage of Lariam over chloroquine is obviously of little use if the side effects of the medicine make hunting dangerous or even impossible.

I have subsequently used "malasone" (not identical to malarone) which is pyrimethamine dapsone, not available in the US or approved by FDA, but available over the counter in most southern African countries and relied on by many PHs of my acquaintance who spend a great deal of time in the bush and, in many cases, have some strain of malaria.

The great problem in this country is that very few physicians have a clue about malaria, its prophylaxis, or its treatment. Your readers should be advised to seek informed advice, which can be difficult to come by. I seem to recall a series of excellent articles published in the African Sporting Gazette within the last decade by a European physician with lots of African experience which offered a very thorough and timely (at date of publication) treatment of the subject. Perhaps you could locate it and re-print it or post it on your website. Few of the effective drugs are either available or approved in the United States, but can often be acquired locally very easily. This may be the best solution, unless you have blind faith in our government regulators.

Best, James O'Neill, Ph.D.

I just finished reading your Malaria Article in April's Hunting Report. I can relate to your article.

In July 1999, my father and I went on an African safari in Tanzania; my first, his fourth. Along with the five shots before leaving for Africa, I was prescribed Larium for Malaria by my family doctor. At the time of prescription being given, I was given a list of all possible side effects of Larium, which I still remember being quite long. Regardless, I took Larium two weeks before leaving, during the trip and after coming home.

Well, I had bad, real bad side effects from Larium and at the time I didn't know what was causing it.

The side effects started as I was boarding the plane in Amsterdam to fly to Arusha, Tanzania. As soon as I stepped on the plane, I had a massive panic attack, my first and one of many during this trip. I thought I was dying and my heart was racing. I somehow managed to stay on my feet, but gave the flight attendant a worried look. I assured her I was ok, but I wasn't. I slowly made my way to my seat, sat down and started to return to normal. 5 minutes later, I almost immediately felt as though I was going to throw up. I got up to get to the bathroom and almost fell over due to a sudden dizziness - I still remember that awkward feeling today. Got to the bathroom and nothing happened - felt fine. This continued for the 8 eight hour trip to Arusha. For the 21 day hunt, I consistently dealt with the dizziness and minor panic attacks. It didn't help that my sensitive stomach had a hard time dealing with the food - Imodium became my close friend.

When I got back, I went to the doctor, explained to him what happened and he told me that there was nothing he could do. Great. The panic attacks continued for a good 4 months after I got back. They never really went away until 2003, 4 years later. (Up until July 1999, I never had a panic attack) In 2006, I started to have them again - strange, really strange. When I have them now, I have learned to control my breathing to at least minimize them.

My suggestion is to NEVER take Larium. There are alternatives. My PH asked me what Malaria meds I was taking. When I told him I was taking Larium, he gave me a strange look and he said "Stupid American doctors. The people in Africa don't Larium b/c of the side effects."

Charlie Mills

Leukopenia is an abnormal decrease in leukocyte (white blood corpuscle) levels. There are a great number of drugs that can cause leukopenia, as well as conditions such as bone marrow disorder. I have to be very careful taking certain medications, especially Antinflamatory drugs like Advil, Ibuphrophen, and some Antibiotics especially Tetracyclines. This type of antibiotic tends to reduce my White Cell Count to about 1,000. Normal range white cell count 4,000 -11,000.

I was bitten by Tsete Flies on both of my legs, they became severely infected, red and swollen, this was due to a reduction in my white count, I believe this was caused by Mefloquine. I used Campophenique to help relieve the itching, pain and burning on my legs, symptoms subsided within a week.

Sincerly,

Doris Mendez

I will report at some length on the experience my young-adult daughter had taking Larium over an extended period, and of the experience my wife and I had taking Malarone over a briefer period.

My daughter, a white American in her early twenties, spend 28 months in Zambia and about a month in Guinea, about six months after returning from her longer trip. The first trip was as a Peace Corps Volunteer. She traveled throughout Southern Africa, but her primary post was in the vicinity of Kasempa, in the Northwestern province of Zambia. She lived primarily in a remote village, assisting farmers in establishing an ongoing aquaculture (fish farming) program. She was not near any major rivers or swamps, but the locality was of necessity one where small streams and ponds were numerous. She lived in a mud-brick, thatch roof house and almost always slept under a treated mosquito net. Her exposure to mosquitoes was still significant, because she worked many days in the immediate vicinity of pond complexes, spend many evenings outdoors around fires, talking and socializing with the locals, and cooked and ate most of her meals in the gazebo (the Bantu/Kaonde word for such a structure escapes me now) immediately in front of her little house.

She took one Larium tablet per week, and claimed to have been very conscientious about always taking it the same day of the week. She reported these results: Insomnia most nights for the first few weeks, and occasionally thereafter, especially the day or two after taking a pill. Unusually vivid dreams the whole time, but none so severe they could be called hallucinations or severe. No psychological effects during waking hours. She had one bout of clinical malaria, with fever, weakness, and dizziness. She described waking up one morning, being sicker than she could ever remember being, and it took her quite a while to summon the strength to get to her feet and shuffle a few steps. She said it took her a surprisingly long time to realize how sick she was, and quoted herself thinking, "Oh, goddamn, this must be what malaria is like." She never thought she was going to die of it, but said afterwards that she could easily see how a more severe case could kill large numbers of people.

The doctor at Mukenge Mission Hospital, in Kasempa, luckily only 30 km. away, monitored the parasite levels in her blood and prescribed only sulfa for a few days. He advised her that she had gotten an unusually heavy "load" of parasites that overwhelmed the Larium. He expressed the opinion that her clinical symptoms were milder and demanded much less aggressive treatment than if she had not been taking the Larium. If her symptoms had been more severe, he would have prescribed quinine, but did not want to do that unless he felt it necessary, as apparently quinine has some unpleasant side effects or contraindications. After those few days, she had no recurrences of clinical malaria. About six months after her return to the USA, she took a shorter trip to Guinea as part of a research trip sponsored by the University of Louisiana at Monroe, incidentally where she is now finishing a postgraduate degree. She had no noticeable side effects during that shorter time on the same drug.

Several months after her return from that trip, when she was confident she would not soon return to any malaria areas, she took a single dose of Primaquin (spelling?), which supposedly purged her body of any remaining malaria parasites, but which I gather cannot be taken often. She has had no malaria symptoms since that time, now approaching three years back in the continental U. S.

My wife and I, white Americans in our early 50's, went to visit our daughter at about the 2/3 point in her Zambian posting. We went in late fall (May), at just the start of the dry season, so there were some mosquitoes about but not the quantity we would have found in the wet summer months. We spent fourteen days in-country, spending a good deal of time near rivers, but spent most evenings indoors and always slept under mosquito nets. We took daily doses of Malarone, as directed. starting a few days before our departure and continuing until a few days after our return from the tropics. We selected Malarone, in spite of its higher cost, because the nurse practitioner at the travel clinic we visited said it produced a lower rate of disturbing dreams and other psychological symptoms then the other drugs available. My wife was more concerned about that than I was, and it turned out that neither of us had the disturbing dreams but I had severe insomnia.

My wife experienced no symptoms at all, while I had really severe insomnia for the first week or so of the trip and milder insomnia for the rest of it. Neither of us experienced unusual dreams or other psychological symptoms. At our first night in Zambia I attributed my sleeplessness to just stored-up adrenalin from all the preparations and excitement over such a major trip, the two long flights (Houston to London to Lusaka), and the time change. Also, I have never slept well in airplanes any time or any where. But, when my insomnia continued for several more nights, I had to attribute it to the drug. Surprisingly, I did not feel groggy or tired or confused during the normal daytime hours, even after nights when I had gotten little sleep.

Thanks for pursuing this survey of effects, and for your tolerance for my rambling on. If anyone had asked me ten or twenty years ago, if I would ever go to Africa and NOT hunt, I would have answered, 'Why in the world would I want to do that?" Well, I did, and it was a grand trip for other reasons. Next trip will probably be to the Namibia or RSA, or to Zimbabwe if the political situation improves, for buffalo and other critters.

Best to you and all others associated with The Hunting Report.

Dean McCormick

Dean McCormick

I am not a travel medicine or infectious disease specialist, so take whatever I have to say with a grain of salt. I do however have a vested interest in keeping up on travel medicine related topics as I am by default the camp doc wherever I am hunting.

Larium is one of the most widely prescibed medications in the world. Vivid dreams and insomnia are well know side effects. I have personally experienced insomnia while one Larium. It is however difficult to say with a high degree of confidence that the drug was the cause. Jet lag, strange food, strange bed, anxiety about the hunt all can of course make a difference in how one rests. Serious neuropsych side effects are know to occur and those with a history of such events are cautioned not to take Larium.

I have used both Larium and malarone in myself and my family. I can report no problems with malarone, other than the daily dosage schedule. I know some have used weekly dosing, but the current recommendation is daily. There is no warning for interaction with coumadin. Some antibiotics can have an effect on the blood concentration of malarone and should be taken with caution. Taking malarone with the antibiotic wouldn't be dangerous, but might not protect against malaria as well. Arrhymthmias (such as missed heart beats) have been noted with Larium.

In my opinion the risks of malaria far outweigh any real or perceived risk of either Larium or Malarone in an otherwise health person.

Doxycycline is a dirt cheap, viable alternative. The daily dosage and potential photosensitivity (increased risk of sunburn) make it less attractive. The photosensitivity is not rare and can be quite debilitating. It is an all or nothing reaction. You either get it, and can't be out in the sun at all, or you don't. One does not get it "a little". I personally have seen several cases.

For what its worth.

Mark S. Jones

Malaria medicine reaction. Two years ago I took the Larium for an extended hunt in Mozambique.

After taking a pill and going to sleep, I had a horrible dream that someone was in my tent holding down the covers to my bed so that I couldn’t move. I thought the bathroom annex to the tent and thatch had been ripped away and that there was nothing I could do about it.

The next pill a week later, I was in a leopard blind dreaming of meeting many of my friends from the States and helping them move to J’burg. About that time my PH squeezed my leg and informed me that a large animal could be heard breathing immediately outside our ground blind. Nothing hit the bait that night, but hyena tracks were all around the blind. In this case reality was scarier than the dream.

There is no question in my mind that the Larium had similar effects on me than it did you. I did not suffer any depression however, I was too glad to be finally hunting in Africa.

Sincerely yours,

James G. Bucher

I have taken Malarone on 2 trips to Africa with no side effects other than a metallic taste In my mouth. I will follow the story closely to see what other readers report.

Gene

Thanks for the article

William Adams