Atovaquone / Malarone is NOT available and frightfully expensive with little data known on the long term effects esp. in children if taking it for long periods of time i.e. travelling across Africa or working in Malaria areas for long periods of time.
But in Lily’s case, one night in Tanzania she woke up screaming about spiders and was holding her hands tightly over her eyes. We tried to calm her down and move them away, but she was adamant to keep them there. It was quiet concerning how afraid she was.
We also noted that this also co-insided with her recent weekly mefloquin dose that was given the previous day, so her blood levels would have been at their highest.
She later settled, but it was difficult to see how distressed she was and made us reluctant to continue to use the drug further because of these side effects.
So it was time to look at other options in conjunction with the vitally important preventative strategy of appropriate topical agents and long sleeves and trousers! Nicky was so precise regarding these clothing exercises which happened every morning before Lily left the tent in the morning and before sunset every day of the journey. Another important preventative step in hind sight was the fact we were traveling between in May – June through these high risk countries which is low season for mosquitos because of the relative colder winter and less humid conditions.
So we decided to use our Malaria test kits in conjunctions with purchasing some combination malarial therapy called Coartem 20/120 [Artemether/lumefantrine] for adults and the paediatric dispersible tablets (For Children 20mg/120mg, for 15kg’s to less than 25kg’s) manufactured by Novartis for Lily which comes as two doses a day for three days. So we decided to change our prophylaxis approach to an active symptom watch and positive testing strategy. Naturally we would have a low threshold to start active treatment with worsening symptoms of i.e. fever/ chills / sweating / headaches / Nausea & vomiting or even if they were worsening general symptoms of fatigue.
The test kits are also easy to work, you just follow the instructions and place 2-3 drops of your blood into a test basin and add 2 drops of reagent and wait for the results, pretty easy to do!
and so far, we are all good!
Nic Andela MBChB(OVS), DAnaeth(SA), GMC mem