Docs debate benefits of malaria drugs

Thursday, December 26, 2002

WASHINGTON -- About 800 Americans a year bring home a bad souvenir from a trip abroad: malaria. A few die, and the rest suffer weeks of miserable symptoms that usually hit shortly after they unpack.

Most of the several million Americans who travel to malaria-plagued countries come home healthy thanks to swallowing protective drugs during the trip.

But the number sickened each year because they didn't take those pills has risen by a few hundred since the mid-1990s. Even as tourism in developing countries grows, too many travelers don't know to take anti-malaria medicines -- or skip them from worry about side effects, such as rare psychiatric symptoms linked to Lariam, the most-prescribed drug.

Now doctors are looking to a meeting of the world's malaria experts in January to settle just which medication is the best choice for different people heading on vacations, military duty or other trips to malaria-ridden countries.

Don't expect a simple answer.

Different risks

The malaria parasite has developed resistance to that old standby drug, chloroquine, in most of the world, rendering it largely useless. That leaves most travelers three options: Lariam, a newer and possibly safer drug called Malarone, and the antibiotic doxycycline.

Each has pros and cons that make declaring a No. 1 choice for everybody all but impossible, cautions Dr. Bradley Connor, a New York travel-medicine specialist.

"Your one-week business traveler vs. your teenage backpacker across Africa have very different risks," agreed Dr. Kevin Kain, director of the University of Toronto's Center for Travel and Tropical Medicine.

All three drugs "work well if you take them," Kain said. Customizing the prescription to each patient's health and destination can limit side effects, ensuring travelers don't abandon their pills.

The advantages and disadvantages are the reason the Centers for Disease Control and Prevention wants to debate the matter at its January meeting, before it updates the government's official health advice for travelers.

Meanwhile, specialists advise people to consult a travel clinic or other doctor with specific expertise in the destination; a regular doctor might not know they need anti-malaria pills.

"It's not in any of our interests to make people sick with malaria drugs. What we're trying to do is stop people from coming back in body bags from their holiday," Kain said.

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