Malaria tablet decisions for Mexico/Yucatan

I'm seeing the nurse tomorrow for my Malaria pills and whatever other jabs I may need. so I've been reading the Wiki about the sort of tablets best for me. Only now I'm utterly confused, as so many websites are contradicting eachother.

The CDC website recommends Chloroquine, other websites say Lariam but the side effects sound very dodgy. I'll be visiting:
Belize
Chiapas
Meridas
Campeche
Chitchen Itza
Bacalar
Cancun

some of which are in the "red zone" on the CDC map. I have a mozzie net, repellant, and spray for my clothes. We are camping for the majority of the 2 week trip, not sure where ie rural, jungle, or proper camping areas - though I don't believe we'll be thrown into deep jungle

Website also says

Risk is very limited; therefore, prophylaxis is not recommended for most travelers to Mexico. Travelers should use personal protection measures such as insect repellents for malaria prevention. Chemoprophylaxis is recommended for the rare traveler going to the risk areas.

http://wwwn.cdc.gov/travel/destinations/mexico.aspx

So are they saying I don't need pills, just sprays and nets etc? I'd rather be safe than sorry TBH....

In short, I'm visiting SOME areas of risk, but nothing ultra-serious I reckon. Though I've no way of telling whether I'll have nasty puking side effects to these pills, I'd like to reduce the odds by choosing something that is widely known to not cause too much tummy-crap!

I'm hoping the nurse will know what's best to prescribe for the areas I'm visiting, it's the Uni clinic not a specialist travel health centre. Some areas of Mexico have drug-resistant mozzies so would defeat the object of taking pills if the bugs are immune!

I hate shoving chemicals and pills into my body at the best of times but I'd rather do that than potentially die of Malaria!

Any advice appreciated....

May I suggest, that instead of seeing a nurse (no offence to the nursing fraternity - whatsoever) about this, you go to a hospital that has a Tropical Diseases Department. It may be out of your way, but they're the Daddys (and Mummys).

Gixer - as always (because it's the right thing to say in these situations and saves some headaches), always check with your medical provider.

With that (now) said - Chloroquine is sufficient and one of the cheapest routes. It also has few side effects. The alternative would be Doxycycline and is also cheap. Both are available as OTCs in Mexico and Belize. Personally, I would opt for the Doxycyxline though you will take that daily where as Chloroquine is taken weekly. Doxycycline is effective in areas where there this Chloroquine-resistant malaria. Some will say you need not take any anti-malarial, but that depends on your own comfort level. Having read your other threads, I'm guessing you will opt for taken the preventative. (Not a bad choice but that's just my personal opinion.)

Skip the Larium (mefloquine). It is in the quinine family of drugs (as is Chloroquine) but the side effects that may occur, considering your destinations, are not worth it. Both meds, mentioned above, are better choices with less complications. The biggest drawback for Doxycycline is the increased reaction to the sun - basically - faster and deeper sunburns. Be sure to use sunscreen with at least a 15 (or greater) SPF factor and reapply it frequently. Secondarily, do not take it right before bedtime as it can cause severe acid-reflux (heartburn). Take it with milk or plenty of fluids and earlier in the day.

Both Chloroquine and Doxycyclne have long-term data available and both are safe for long-term use. Doxy can be used up to 2 years (non-stop) duration. Though it is an antibiotic, the dosage used is very low and should you need antibiotic treatment for an injury or disease, you should experience no problems with that - as long as you tell the doctors you've been taking the Doxy as an anti-malarial.

If you have any questions or comments, send a PM to me.

Well the nurse was lovely and spent about half an hour with me, and she recommended Chloroquine (Avloclor). The potential side effects scare the crap out of me though and I really am not looking forward to taking them. The Pharmacist said that if you read potential side effects for the simplest of drugs you'd not want to take them either, so what can you do? My friend said her son took Chloroquine and was fine, my other colleague said his wife took it and it gave her awful mood swings and crying fits.

I have to take the first dose today as I fly in a week, so at least if I have any bad reactions I can go back to the docs. I am a very healthy person and eat tons of fruit and veggies and no junk food. I'm rarely ill so have a good immune system, I don't smoke or drink or take any other drugs/medicines, so I'd like to think my body will cope with whatever the heck I'm about to take I'm buying a DEET spray for my mozzie net as I don't think it's treated, and I'm putting it on my clothes too, as well as the mozzie repellant on my skin. The nurse wasn't too keen about the plant-based organic mozzie cream I've got though, which just added to my paranoia. FFS.

What the hell, I'm just gonna do it - not gonna let it ruin this once in a lifetime trip

Gixer - your pharmacist is correct. If you read all of the side effects for aspirin, you'd think twice. Chloroquine is a good choice and very effective. Very few people actually experience any side effects at all. Be sure to take it with plenty of fluids which will reduce the chances of any stomach upset down to basically zero. Also try to take it about an hour after a meal rather than on an empty stomach. It is very well tolerated - really. Because it is only taken weekly, just remember to take it and do not stop taking it early. By that I mean, be sure to finish the course which ends 3-4 weeks after leaving a malarial area (if continuing your travels) or you return home. Finishing the meds as directed is very important.

Beerman and I used Chloroquine while in Panama and neither of us had any side effects at all. We actually took most of them on an empty stomach with our morning coffee and still did not have any problems. Keep in mind, "potential" side effects does not mean "guaranteed" side effects.

Enjoy your adventure!!!!

Risk is very limited; therefore, prophylaxis is not recommended for most travelers to Mexico. Travelers should use personal protection measures such as insect repellents for malaria prevention. Chemoprophylaxis is recommended for the rare traveler going to the risk areas.

http://wwwn.cdc.gov/travel/destinations/mexico.aspx

So why are you taking this stuff?

I've been to most of those places and have never taken anti-malaria pills.

Yes I saw that and I still haven't taken the pills yet. I think I got them because of the "err on the side of caution" part of me. I'd email Trek America and ask about incidences of Malaria in the areas we are going to but I reckon they'd stay on the safe side and recommend taking pills, they'd be scared to NOT recommend pills in case I then got Malaria and tried to sue them!

I still dunno whether to take them or not.....I've got some clothing spray now with Permethrin in, I'm treating my mozzie net, got cream for my skin, and will be covering up at night times. Maybe that'll be enough..... I just rerally don't want to flood my system with whatever the hell is in these pills....

Don't take anything!!!!

Paludismo/malaria isn't at all common in those areas and my bet is that your friendly nurse hasn't been further then the shopping mall in her whole life.

I've been all over southern Mexico/the Yucatan-spent months there in fact-never met anyone who had Malaria.

Malaria in Mexico? I think this "swine flu" scare is blowing lots of things out of proportion. I agree with SalmonSam--the odds of getting this in Mexico are remote in the extreme (unless you are planning on camping in a swamp for a few months).

Reply from Trekamerica:

This is a tricky one. I have been on this trek and no-one on the trip was taking malaria tablets (me included). We have to say go with any medical advice as we aren’t qualified to give this. Mosquitoes are pretty bad in the evening, and we all got bitten. No malaria though! They do advise to take tablets if going into jungle areas (i.e. Palenque), but it really is up to you. If you want to be safe then take them, but some people choose not to as they do not like putting chemicals in their bodies.

Good job with the mosquito net. We bought hammocks and slept out – you definitely need one if you are planning on doing that. Basically, the risk is very low, but there is still a risk.

We're going to Palenque for 2 days Oh well, too late to take the pills now.....will just lather up with cream and repellants....

[ Edit: Edited on 15-Jun-2009, at 05:20 by Gixer ]