Trying to decide what to do about Malaria medication was without a doubt one of the more stressful parts of planning a trip to Africa. With the exception of South Africa, almost everywhere my 56 day overland trip would visit was designated a Malaria Zone.
To take it or not to take it… I had to first decide if I even wanted to take anti malaria pills since the side effects can be fairly severe and even if you take them you might still get malaria. After having a lot of people weigh in on the matter, I concluded that the side effects of malaria pills were not half as bad as malaria itself. This was a personal choice. If you have searched the topic on the internet you will see that there is no clear right or wrong answer, so be prepared to decide for yourself. I am not a medical professional and would recommend speaking to a medical professional before you make a decision.
What to Take… I looked at three options for anti Malaria medication…
Larium (Meflquine) taken once a week
Malarone taken once per day and a few days before and after the trip
Doxycycline taken once per day during the trip and for 4 weeks after the trip.
I went with Malarone and here is why.
Larium is a pill taken once a week. This is nice because you do not need to remember to take a pill everyday, although that is sometimes easier to remember than once a week. The major side effect of this pill is horrible nightmares. They say that if you have a history of mental illness or depression you should not take Larium. I was going to take Larium since I have no pre-existing conditions and thought I could handle the nightmares, but it turns out that Larium has very negative mental side effects when you are under pressure, so scuba diving is not allowed (or strongly discouraged) while taking this medication. Since I am a scuba diver I had to rule this out. Going bonkers 20 meters below the surface did not appeal to me.
As for Doxycycline, there are a lot of pros and cons. First pro is that it is way less expensive than Malarone. On the USA Costco pharmacy website 50 pills cost $7.18. You do have to continue taking Doxy long after you are out of a Malaria Zone unlike the other two. Also, because it is an antibiotic, it might help treat some other issues too. The negative side is that the list of side effects seems to be much longer than that of Malarone. The fact that it is an antibiotic is more of a negative point for women than men since taking antibiotics can cause repeated cases of yeast infections in women (did I just lose a few male readers?) and antibiotics interfere with the effectiveness of oral birth control. It also causes sensitivity to the sun. This does not necessarily mean you will burn faster as some people say just put on more sunscreen, but friends who have taken it have said that when the sun was on their skin it caused a very intense burning sensation.
Malarone has some side effects, but not as many as Doxy. You only have to take it a few days before and after being in a Malaria Zone unlike Doxy. It is not an antibiotic so the issues Doxy causes for women mentioned above do not occur. The major downside is that a pack of 12 pills costs roughly $65. When going on a multi week trip this can add up.
In the end I figured that I was investing a lot of time and money into my travel as it was and wanted to enjoy myself. There are certain times to cheap out on things, but for me this was not one of them. After spending almost 2 months on Malarone the worst I experienced was an upset stomach from time to time, but it was nothing I had not experienced on other trips while not on Anti-Malarials.
Purchase your Malarone from Costco, it is much cheaper than at regular pharmacies. Call in a few days ahead of time as they often do not have much in stock at any given time.
Take your Malarone in the morning with breakfast. This way you are not having it on an empty stomach and it has time to run through your liver before you start evening drinking. You are going to be on vacation after all!
If you do decide to take Doxy, take pro-biotics every day. If you are a woman make sure you have medication for a yeast infection and alternative contraception to the pill during the time you are taking Doxy.
If you are going to be in a Malaria Zone for longer than 3 months you will not be able to stay on Anti-Malarials as they are too hard on your system.