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 Post subject: Re: Malaria
Unread postPosted: Tue Aug 09, 2011 10:28 am 
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Hi dcbee

It is highly unusual to be allergic to every class of antibiotics on the market, so I would wonder what classes you are indeed allergic to - the most common are penicillin and sulphonamides. Also, when you say you're allergic, what actually happens? In other words, do you swell up and have to be rushed to hospital, or is it just gastrointestinal discomfort or vomiting?

Remember that antibiotics are designed to kill the bacteria in one's system and do not kill human cells; the side-effects are a result of disturbances to human systems, such as an imbalance of "good bacteria" in the gut. Malarone (atovaquone with proguanil) also attacks foreign organisms, not human cells: it works by interfering with the growth of parasites in the red blood cells of the human body. Perhaps in that way it is similar, although it is a schizonticide and not an antibiotic.

Technically speaking, the beginning of October defines the boundary between low and high risk areas in seasonal malarial areas in South Africa. Therefore, October to May is considered high risk in Kruger and both the World Health Organisation and the South African Department of Health recommend the use of antimalarial tablets in addition to non-drug measures (antimalarial sprays, netting, citronella-oil products, long sleeves and trousers, etc.).

I say technically because there are other factors that affect the proliferation of mosquitoes, most especially the advent of the rainy season. If it is still dry and there is an obvious dearth of mosquitoes when I go to Kruger at the beginning of October, or the end of May, I tend to not use antimalarial tablets - although I always indulge in non-drug measures - but that is only what I do, and is not necessarily a recommendation for others, especially as the official guidelines state otherwise.

Ultimately, you need to decide what you want to do regarding taking antimalarial tablets or not. It depends on various personal factors too, which only you can consider and weigh up.

As to staying outside Kruger and doing day-trips in, I agree wholeheartedly with the others. I did it only once and I will not do it again in a great hurry! Stay in Kruger if you can - you will not be sorry from a game-viewing experience.

Though it is true that mosquitoes do not honour human geographical boundaries, one must remember that certain areas outside Kruger may not be diligent enough in spraying and controlling their mosquito populations on a regular basis. Kruger is indeed diligent (as far as I know) and most of their accommodation, in my experience, has netting, although some of the older accommodation may have not had the netting sufficiently repaired to prevent mosquitoes squeezing through. Nevertheless, I have seldom had problems with mosquitoes inside the accommodation - mostly, I get bitten outside between dusk and dawn - and, in summer, I further restrict mosquito access within units by keeping the air conditioning on.

There are indeed some places outside Kruger that are all-year-round low risk - such as Hazyview and Hoedspruit - but my choice, if I had yours, would still be to stay in Kruger and take suitable and sensible precautions against malaria infection. Remember that a low-risk does not mean no risk, although it IS lower than a high risk area.

Whatever you do, dcbee, enjoy your trip to the full!

Regards,
OWN.


Disclaimer: My recommendations here - though based on some experience and some drug knowledge - are not absolute, and further consultation with suitable health-care professionals is suggested before a final decision is taken on whether to enter a malarial area, what prophylaxis to use, and any general factors and limitations that need to be taken into account. Furthermore, I only advise based on what information is given by the person(s) entering the malarial area, but I have no control on the information given to me, and so such information could possibly be incomplete or misleading.

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 Post subject: Re: Malaria
Unread postPosted: Tue Aug 09, 2011 9:45 pm 
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The best advice when taking medication or not is to cover up thoroughly from dusk till dawn. Spray or rub creams behind necks, over and around ears, behind knees and the soft parts of the forearms and wrists. Take care


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 Post subject: Re: Malaria
Unread postPosted: Wed Aug 10, 2011 12:06 am 
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Ouma Biskuit wrote:
The best advice when taking medication or not is to cover up thoroughly from dusk till dawn. Spray or rub creams behind necks, over and around ears, behind knees and the soft parts of the forearms and wrists. Take care


Yes, and also apply suitable antimalarial sprays or creams on the ankles (where I get bitten most) and on the soft parts of the skin between the toes, and, if possible, a dab on the temples too. Avoid spraying them onto the face though - if I only have a spray, then I spray onto the palm and then apply to appropriate parts of the face and neck, avoiding the eyes and mouth.

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 Post subject: Re: Malaria
Unread postPosted: Wed Aug 10, 2011 5:27 pm 
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Hello, everyone! Thanks for all the input. You've convinced me to stay inside the park after all! :D

@OWN, I am allergic (very high fever + hives everywhere) to every class of antibiotics I've tried, which are amoxicilin, azythromycin, and sulpha drugs. So I guess technically I could still try another, but I'm not especially eager to...

I bought myself some 35% DEET lotion and insect repellent pants, shirts, and socks, so now I just have to figure out what to do about taking drugs.


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 Post subject: Re: Malaria
Unread postPosted: Wed Aug 10, 2011 5:58 pm 
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Not pleasant to be allergic to so many classes of antibiotics, and commonly used ones at that, dcbee. :( I understand your reticence to avoid any other classes. I do see, though, that you haven't mentioned the tetracyclines - not sure if you've ever used them - to which doxycycline would belong. Something certainly to consider, especially during the rainy seasons in summer, if you're visiting high-risk malarial areas. Otherwise the combination of atovaquone (an analogue of coenzyme Q10) and proguanil, or mefloquine (a synthetic analogue of quinine), should also hopefully be okay. Whenever you decide to use antimalarial medication, rather do a test run several weeks before you're planning to use them; just in case.

Disclaimer: My recommendations here - though based on some experience and some drug knowledge - are not absolute, and further consultation with suitable health-care professionals is suggested before a final decision is taken on whether to enter a malarial area, what prophylaxis to use, and any general factors and limitations that need to be taken into account. Furthermore, I only advise based on what information is given by the person(s) entering the malarial area, but I have no control on the information given to me, and so such information could possibly be incomplete or misleading.

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TR: NECTAREAN NICETIES OF THE NORTH
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 Post subject: Re: Malaria
Unread postPosted: Thu Sep 01, 2011 10:30 pm 
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Friends have just arrived today at Punda Maria. Luggage got lost (or delayed?) from Netherlands... they only have enough Malarone for a few days.

Is it possible to obtain Malarone anywhere north of Phalaborwa Gate... close as possible to the Park, and with a weekend coming up? I really don't know much about Thohoyando, is that an option????

(They also need contact lens fluid & cheap clothes for the lady)


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 Post subject: Malarone near Punda Maria?
Unread postPosted: Thu Sep 01, 2011 10:33 pm 
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Friends have just arrived today at Punda Maria. Luggage got lost (or delayed?) from Netherlands... they only have enough Malarone for a few days.

Is it possible to obtain Malarone anywhere north of Phalaborwa Gate... close as possible to the Park, and with a weekend coming up? I really don't know much about Thohoyando or Giyani, is either an option????

(They also need contact lens fluid & cheap clothes for the lady)

:(


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 Post subject: Re: Malarone near Punda Maria?
Unread postPosted: Thu Sep 01, 2011 10:55 pm 
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Malarone is not an over the counter medicine as far as I remember. So that may be a problem. However it is a small one unless they have medical reasons for wanting to use it. It's a low risk time, I would not be taking anything.

As for shopping Giyany is the nearest larger town. At 80 km from the gate. But I would not happily go there.
The park shop might have stuff, they can claim the cost at the airline anyway, but it might hit their travel budget a bit...

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 Post subject: Re: Malarone near Punda Maria?
Unread postPosted: Thu Sep 01, 2011 11:09 pm 
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Malarone is Malanil in ZA and is a prescription item. Try the park shop first. They normally keep anti malarial prophylactic but not malanil.

Advise to use peaceful sleep or tabard and avoid getteing mossie bites. It is low risk time and we have not had first rains yet but not advisable to tell them not to take anything as they may be high risk due to medical reasons as you point out.


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 Post subject: Re: Malaria
Unread postPosted: Fri Sep 02, 2011 6:34 am 
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I don't know the area well enough to suggest a pharmacy there, Wilmaw. However, Malarone is only on prescription in SA, so the options will be either a pharmacy that will assist with a few tablets without your friends having a script (there are ways they can do this without breaking the law) or to find a dispensing doctor that has the tablet in stock.

If they haven't started the Malarone course as yet, then another antimalarial may be an option, although it will also be on prescription only. One must also remember that this time of the year is still officially a low-risk antimalarial time (high risk officially begins at the beginning of October), so they might consider not using antimalarial tablets and perhaps only diligently-applied non-drug measures; although it must be said that one cannot rule out risk of contracting malaria altogether, and so the decision to use tablets or not is their choice alone.

If I was them, I would ask the local staff at Punda (ranger, shop manager, reception people, etc.) what they suggest, and where the nearest pharmacy or doctor is located.

Hope they come right. :thumbs_up:


Disclaimer: My recommendations here - though based on some experience and some drug knowledge - are not absolute, and further consultation with suitable health-care professionals is suggested before a final decision is taken on whether to enter a malarial area, what prophylaxis to use, and any general factors and limitations that need to be taken into account. Furthermore, I only advise based on what information is given by the person(s) entering the malarial area, but I have no control on the information given to me, and so such information could possibly be incomplete or misleading.

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EVERYBODY'S TR!
TR: A NEW DAY IS S-OWN
TR: NECTAREAN NICETIES OF THE NORTH
TR: PRIMEVAL PLEASURE

"Outside of a dog, a book is a man's best friend. Inside of a dog, it's too dark to read." (Groucho Marx)


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 Post subject: Re: Malarone near Punda Maria?
Unread postPosted: Fri Sep 02, 2011 7:17 am 
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wilmaw, I think you should make contact with a chemist where they would be able to collect the meds from. Possibly Phalaborwa would be your best bet. Explain the situation, I'm sure there is a way the prescription could be filled in for them. They might require their doctor or chemist from Holland to email or fax the original prescription.

I'm sure they would understand and do all they can to help. :)
We once went on holiday and I left all SO's prescription meds behind. I had a quick chat with the local chemist after a call to my doctor, chiff-chaff, I walked out with all I needed. :wink:

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 Post subject: Re: Malaria
Unread postPosted: Fri Sep 02, 2011 10:00 am 
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Hello forumites, my adult son is epileptic and we plan to take him to Kruger next February, however, I've always read that people taking anti-convulsants can't take anti-malaria meds. Obviously the risk of contracting malaria in the summer is much higher so am therefore worried. Would be interested to hear from any other forumites who have this same condition and what they do in this case.

Thanks very much


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 Post subject: Re: Malarone near Punda Maria?
Unread postPosted: Fri Sep 02, 2011 10:13 am 
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Sorry to hear about the luggage problems; hope it all get's resolved quickly & smoothly...

As for the Malarone; there's a very good lesson to be learned here...

We NEVER pack prescription medicines in check-in baggage. ALL such items come on-board with us in hand-luggage! Too late now for this case; but hopefully anybody who reads the thread will take note...

Cheers...

PS: I only looked at the thread because we've just picked our Malarone scrip up - astronomical price :evil: Still - on the up side - just 5 weeks to go... :D


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 Post subject: Re: Malarone near Punda Maria?
Unread postPosted: Fri Sep 02, 2011 12:56 pm 
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Thank you everyone!

When I called they were in a town "80km from the gate" which I assume must be Giyani. It seems they found a doctor there.

I am always in 2 minds about taking pills in the "low season" especially since trips are sometimes for 2 days only... it's like insurance or medical aid contributions - you must maar take it because if you don't and you should have, you'll regret it.

Malaria is too scary to mess around with so my motto to others is also "rather safe than sorry". It is the biggest killer in Africa after all.


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 Post subject: Re: Malaria
Unread postPosted: Fri Sep 02, 2011 1:43 pm 
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FRUITBAT I am sure OWN will offer you some good advice soon but the only other suggestion I could give would be to consult with your doctor on this issue.

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