Welcome to the new medical info page,the purpose of this is to keep people informed of the latest news concerning drugs for there holiday and has been taken from the concerned websites.This is to save time for fellow travellers trolling the internet and the links where this info was taken will also be posted so you can check the info if you want to.
Malaria, an introduction
Malaria is widespread in many tropical and subtropical countries and is a serious and sometimes fatal disease. You cannot be vaccinated against malaria, but you can protect yourself in three ways:Avoidance of Bites
Mosquitoes cause much inconvenience because of local reactions to the bites themselves and from the infections they transmit. Mosquitoes spread malaria, yellow fever, dengue and Japanese B encephalitis.
Mosquitoes bite at any time of day but most bites occur in the evening.
Precautions to Take
1:-Avoid mosquito bites, especially after sunset. If you are out at night wear long-sleeved clothing and long trousers. 2:-Mosquitoes may bite through thin clothing, so spray an insecticide or repellent on them. Insect repellents should also be used on exposed skin. 3:-Spraying insecticides in the room, burning pyrethroid coils and heating insecticide impregnated tablets all help to control mosquitoes. 4:-If sleeping in an unscreened room, or out of doors, a mosquito net (which should be impregnated with insecticide) is a sensible precaution. Portable, lightweight nets are available. 5:-Garlic, Vitamin B and ultrasound devices do not prevent bites.
Taking Anti-Malaria Tablets
1:-Start before travel as guided by your travel health advisor (with some tablets you should start three weeks before). 2:-Take the tablets absolutely regularly, preferably with or after a meal. 3:-It is extremely important to continue to take them for four weeks after you have returned, to cover the incubation period of the disease. Atovaquone/proguanil (Malarone) requires only 7 days post-travel)
Drugs Most Commonly Used for Malaria Prevention
Travellers must always, through discussion with their doctor or pharmacist, make sure they use a drug which they can tolerate (only the more common side effects are given here) and one which is appropriate for their destination(s). No drug is 100% effective.
Chloroquine (licensed for prophylaxis in UK) Preparations available: Avloclor® (Zeneca) and Nivaquine® (Rhône-Poulenc Rorer). Adult dose is 2 tablets (each containing 150mg chloroquine as base) taken once a week. Nivaquine is available in syrup form. Consider a trial course before departure, if using this regime for the first time, to detect if you are likely to get side effects (e.g. for two weeks). Otherwise, when possible, chloroquine should be started one week before exposure (to ensure adequate blood levels), throughout exposure and for 4 weeks afterwards. Nausea and sometimes diarrhoea can occur which may be reduced by taking tablets after food. Headache, rashes, skin itch, disturbance of visual accommodation (often expressed as blurred distance vision which may take up to 4 weeks to reverse) or hair loss may warrant changing to alternative drugs. Retinopathy (eye changes) which can be permanent is unlikely to occur until 100g have been consumed (i.e. over 5 years treatment at prophylactic doses). Caution in liver and renal disease. Can aggravate psoriasis and very occasionally causes a convulsion so it should not normally be used in those with epilepsy. Chloroquine is very toxic in overdose - parents must take special care to store the tablets safely.
It is generally accepted, as a result of long usage, to be safe in pregnancy.
Mefloquine® (licensed for prophylaxis in UK)
Preparations available: Lariam® (Roche). Adult dose is 250mg weekly. One dose should be taken a week before departure and it should be continued throughout exposure and for 4 weeks afterwards however three (3) doses at weekly intervals prior to departure are advised if the drug has not been used before - this can often detect, in advance, those likely to get side effects so that an alternative can be prescribed. Not licensed in Britain for use for more than 1 year (in countries where it is licensed for more than 1 year, additional side-effects are rare). Nausea, diarrhoea, dizziness, abdominal pain, rashes and pruritis can occur. Headache, dizziness, convulsions, sleep disturbances (insomnia, vivid dreams) and psychotic reactions such as depression have been reported. These reactions most commonly begin within 2-3 weeks of starting the drug and may be worse if alcohol is taken around the same time as the mefloquine. Avoid in epilepsy, if there is a close family history of epilepsy (e.g. parents or siblings) or if there is a history of psychiatric illness. Caution, and avoid if alternatives are available, in severe renal or liver failure and those with heart rhythm defects. Also caution in those taking digoxin, beta or calcium channel blockers when arrhythmias and bradycardia can occur. Although there is no evidence to suggest that mefloquine has caused harm to the foetus it should normally be avoided during the first trimester of pregnancy or if pregnancy is considered possible within 3 months of stopping prophylaxis
Proguanil (licensed for prophylaxis in UK)
Preparations available: Paludrine® (Zeneca). Adult dose is 200mg daily. Can normally be used continuously for a period of up to 5 years. One or two doses should be taken before departure. It should be continued throughout exposure and for 4 weeks afterwards. Anorexia, nausea, diarrhoea and aphthous (simple) mouth ulcers can occur. Can delay the metabolism of the anticoagulant, warfarin, and result in bleeding. Those planning to take warfarin must discuss this with their doctor before starting any treatment. Caution in renal impairment.
Considered to be safe in pregnancy, but folate supplement is advised.
Doxycycline (licensed for prophylaxis in UK) Preparations available: Doxycycline (non-proprietary), Vibramycin® (Invicta). Adult dose is 100mg daily. Can normally be used continuously for a period of at least 6 months - be guided by your doctor. Consider a trial course before departure, if you are using this regime for the first time, to detect if you are likely to get side effects (e.g. for one week). Otherwise doxycycline need only be started just before exposure (e.g. 2 days), continued through exposure and for 4 weeks afterwards. When other tetracyclines are being already used for acne this will provide protection against malaria so long as an adequate dose is taken (you can change to 100mg doxycycline per day if your doctor agrees). Erythema (sunburn) due to sunlight sensitivity can occur. Use of sunscreens is especially important and if severe, alternative prophylaxis should be used. Heartburn is common so the capsule should be taken with a full glass of water and preferably while standing upright. Contraindicated in pregnancy (including one week after completing the course), breast feeding, in those with systemic lupus erythematosis, porphyria and children under 12 years because permanent tooth discoloration can occur. It may reduce the effectiveness of the oral contraceptive pill, you should discuss this with your family planning advisor.
Occasionally anorexia, nausea, diarrhoea, candida infection and sore tongue (glossitis) have been reported and rarely hepatitis, colitis and blood dyscrasias.
Atovaquone plus proguanil (licensed for prophylaxis in UK) Preparations available: Malarone®. Adult dose is one tablet daily - each tablet contains 250mg atovaquone plus 100mg proguanil. Child doses will be based on the weight of the child but will be once daily also. DO NOT confuse with Maloprim® which is not now advised for prophylaxis since more effective alternatives are available. Should be taken for 1 or 2 days before entering the malarious area, throughout exposure, and for 7 days after leaving the infected area. Licensed for trips of up to 28 days but there is no evidence of increased side-effects if used for longer. Atovaquone/proguanil need only be commenced one or two days before exposure. Abdominal pain, headache, anorexia, nausea, diarrhoea, coughing and aphthous (simple) mouth ulcers can occur. Absorption may be reduced in diarrhoea and vomiting, and blood levels are significantly reduced with concomitant use of tetracyclines, metoclopramide and especially rifampicin or rifabutin. The proguanil component can delay the metabolism of the anticoagulant, warfarin, and result in bleeding. Those planning to take warfarin must discuss this with their doctor before starting any treatment. Caution in renal impairment. Lack of experience in pregnancy and during breast feeding means that it should be avoided in these circumstances unless there is no suitable alternative.
The high cost makes popular for short trips.
Following these guidelines faithfully might not guarantee complete protection. If you get a fever between one week after first exposure and up to two years after your return, you should seek medical attention and tell the doctor that you have been in a malarious area.
Confirm primary courses and boosters are up to date as recommended for life in Britain - including vaccines given to special groups because of risk exposure or complications (e.g. hepatitis B for health care workers, influenza and pneumococcal vaccines for the elderly). Courses or boosters usually advised: diphtheria; tetanus; poliomyelitis; typhoid; hepatitis A; yellow fever.Vaccines sometimes advised: meningococcal meningitis; hepatitis B; rabies; tuberculosis; cholera.Yellow fever certificate required if over 1 year old and entering from an infected area.
Notes on the diseases mentioned above Tetanus is contracted through dirty cuts and scratches and poliomyelitis spread through contaminated food and water. They are serious infections of the nervous system. Typhoid and hepatitis A are spread through contaminated food and water. Typhoid causes septicaemia and hepatitis A causes liver inflammation and jaundice. In risk areas you should be immunised if good hygiene is impossible. Cholera is spread through contaminated water and food. More common during floods and rainy seasons. Those unable to take effective precautions, for example, during wars and when working in refugee camps or slums may consider vaccination. Tuberculosis is most commonly transmitted via droplet infection. Those going to countries where it is common, especially those mixing closely with the local population and those at occupational risk, e.g. health care workers, should ensure that they have previously been immunised. Check with your doctor or nurse. Meningococcal meningitis and diphtheria are also spread by droplet infection through close personal contact. Vaccination is advised if close contact with locals in risk areas is likely. Yellow fever is spread by mosquito bites. It is uncommon in tourist areas but can cause serious, often fatal illness so most people visiting risk areas are immunised. http://www.fitfortravel.nhs.uk/advice/diseases/yellowfever.htm Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse, It affects the liver, causes jaundice and occasionally liver failure. Those visiting high risk areas for long periods or at social or occupational risk should be immunised. Rabies is spread through bites or licks on broken skin from an infected animal. It is always fatal. Vaccination is advised for those going to risk areas that will be remote from a reliable source of vaccine. Even when pre-exposure vaccines have been received urgent medical advice should be sought after any animal bite