Anti Malaria Medication for Dominican Republic

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QUESTION

I am from the UK and am planning to go to the Dominican Republic (Punta Cana) in October. I have been prescribed Malarone from the nurse at my local GP’s, although my mothers nurse informed her that this drug is not suitable for this area? I would appreciate any help, many thanks.

ANSWER

Malarone is suitable for travel to the Dominican Republic. However, the type of malaria found there is also still considered sensitive to chloroquine, so chloroquine is also an acceptable form of chemoprophylaxis for travel to this country. Mefloquine and doxycycline can also be taken.

Preventative Medication for Malaria in Dominican Republic

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QUESTION

I just read the CDC recommended medicines for preventing malaria and I am confused. It gives the pros and cons for taking one drug over another. My husband and I are in excellent health, we need our td boosters. Our 15 year old is current in his vaccinations. We will be in D.R. for 2.5 weeks near Jarabacoa then Rio San Juan. We will be on a missionary trip. What medicine should be take in your opinion before hand?

ANSWER

Apart from some basic differences, particularly regarding which forms of malaria they are effective and against, and in what areas of the world, the choice of which anti-malarial to take mostly comes down to personal preferences. So, for example, in most of Africa, malaria is resistant to chloroquine, so this drug is not recommended for travellers; conversely, in parts of Thailand, malaria is resistant to mefloquine, so likewise, if travelling to those areas, you would need to pick another drug.

Having said that, in the Dominican Republic the malaria is sensitive to all forms of anti-malarial drugs, so you don’t have to worry about that. Between the four main types of drug you can take (atovaquone-proguanil, doxycycline, mefloquine and chloroquine), there are significant differences in price, frequency and duration of taking the tablets and side effects, all of which may influence your decision to take one over another. They are all roughly equal in terms of their efficacy in preventing malaria, apart from when resistance is an issue, as I’ve mentioned.

Of the four, chloroquine and mefloquine are taken weekly, while atovaquone-proguanil (often sold as Malarone) and doxycycline are taken daily. Some people prefer the convenience of only having to take a pill every week, but the disadvantage is that these both have to be started 2 weeks before you travel, whereas the daily medications can be started the day before you leave. While Malarone only needs to be taken for one week after returning from your trip, the others should be taken for a full four weeks, to ensure that malaria does not surface once you’re back.

All have some reported side effects, but in my experience, Malarone has the fewest and the most mild, though some people report upset stomachs and disturbed sleep. Chloroquine also has some potential gastrointestinal side effects and can also produce itching, which is a particularly common side effect in people of African descent. The tablets have a metallic taste which some people find unpleasant.

Doxycycline is also an antibiotic, which means it can also help prevent other infections while travelling, though one of its common side effects is sun sensitivity, which may make it less suitable for travelling in tropical areas (personally I have not experienced this side effect, though I have known many people who have).

Mefloquine (sold as Lariam) is not recommended for people with a history of mental illness, and is known to have psychiatric side effects, including nightmares, hallucinations and even altered behavior (again, my whole family took Lariam during one trip, and no one experienced any such side effects, but you should be aware of the possibilities).

Another important factor to consider is price: doxycycline is usually the cheapest drug, and Malarone the most expensive (could be as much as $100 for each of you, for enough to cover the 2.5 week trip, plus a week of tablets once you get back), with the others somewhere in between.

Again, ultimately the choice usually comes down to what factors are important to you and your personal preference. I tend to pay the extra for Malarone since I prefer the convenience of starting the pills right before I leave, and only taking them for a week when I return. Furthermore, when I am away, I am usually working outside, and so would rather not risk the potential sun sensitivity side effect of doxycycline. You should also talk with your doctor about what is usually available in your area from local pharmacies, as they may not carry the full selection of choices.

Malaria from Dominican Republic?

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QUESTION

Hi i just came back from the Dominican Republic. I started to have a mild fever, chills, muscle pains, a headache, and a cough. Today the fever and chills are gone but my cough and headache have gotten worse. It hurts my head a lot when I cough, I feel a lot of pressure in my head. Can you please tell me why my head hurts so much.  Is this a symptom of malaria? hope to hear from you guys soon thanks!

ANSWER

Headaches can be caused by many things – they are usually classified as primary (tension headaches, migraines or cluster headaches), secondary (as a side effect to some other illness or syndrome, which can very commonly be an infection or response to an allergen) and neuralgia and “other” headaches (neuralgia is inflamed nerves). Malaria, as a serious infection, can cause secondary headaches, while other symptoms include fever (usually in cycles of 2 or 3 days), chills, nausea and aches. However, these symptoms are also consistent with a wide range of other illnesses, including influenza and other common diseases. Malaria symptoms will only appear at least one week after being bitten – if you have started feeling symptoms sooner than this, then you probably don’t have malaria.

Malaria is present in the Dominican Republic, with highest transmission risk in the western part of the country, near the Haitian border. The cities of Santiago and Santo Domingo are considered very low risk for malaria. It is actually recommended that all travellers to the DR take anti-malarial medication (called prophylaxis), to protect against malaria infection. If you were taking prophylaxis, then the risk of getting malaria is very low. However, if you were visiting areas outside of these cities, were not taking anti-malaria medication and it has been at least a week since you were bitten by mosquitoes while there, it may be worth going to your doctor or a hospital to have a malaria test. If you are diagnosed with the disease, then your doctor can quickly prescribe you effective treatment, which should clear up the infection in a matter of days. The type of malaria in the Dominican Republic (Plasmodium falciparum) can be dangerous if left untreated, though in this area, it responds readily to several different drugs, including chloroquine, so treatment will be uncomplicated.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!