Author Topic: Malaria and Meds  (Read 11965 times)

Diver Rick

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Malaria and Meds
« on: March 13, 2009, 17:49:28 UTC »
I was looking for some opinions about malaria prevention.   I am going to Wakatobi resort in May.  (Southeast Sulawesi area of Indonesia).  We will also be in Bali for a few days en route, and Singapore on the way home.

If you've been to this area before, which Malaria med were you prescribed?

I keep getting conflicting info about which one is good for that area, and which meds won't prevent me from diving!

Thanks for any and all info.


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Re: Malaria and Meds
« Reply #1 on: March 17, 2009, 12:11:22 UTC »
Hi Rick,

Best advice is to get advice from an expert in travel medicine. To set it up, go the International Society of Travel Medicine (ISTM) website ( and enter the Travel Clinic Directory at the top of the menu on the left hand side of the page.  Or the International Association for Medical Assistance to Travellers (IAMAT)(

First order of business in preventing malaria (and dengue fever, yellow fever, etc.) is to avoid getting bitten by an infected mosquito.  This updated and edited version of my "Ask RSD" article on the topic appeared in Rodale's Scuba Diving:

"The danger and bother of insects can be substantially reduced by these precautions: (1) Wear long sleeves and pants, avoiding dark or bright colors, especially at dawn and dusk. Protective clothing such as the "Buzz Off" brand can be useful ( As an extra precaution, you may treat clothing with permethrin (As in the easy to use Sawyer Products;

(2) Try to stay indoors at dawn and dusk when many flying insects are most active (although the mosquito that transmits dengue is most active during the daytime), and avoid sandy areas as much as possible at any time of day, especially when there is no breeze. When making reservations, make sure the resort has screened windows;

(3) Wear insect repellent. The best protection against these and other insects arguably is full strength DEET. Some divers like things such as Avon's Skin-So-Soft and Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for long-lasting effectiveness.

Most DEET containing repellents are the 15-30% range of concentration. The testing of various strengths of DEET has shown that after about 30% little additional effectiveness is to be had by upping the strength, and even less after about 50%. As such, there is simply no point in exposing oneself to more potent brews. UltraThon at 32% ( appears to be a good product. Used as directed over relatively brief periods of time, say a week, DEET has been shown to pose no significant risk when applied to exposed skin. If you wear lightweight, loose fitting clothes, it generally is safe to use DEET underneath. Doing so with heavy, snug fitting clothes can result in dermatological problems and worse. Be aware that DEET can dissolve synthetics like plastics, rayon and nylon, so it's best to wear natural fibers and keep it off of your gear.

Relatively recently, picaridin-based repellants have been found to be quite effective and much less irritating to the skin and malodorous than DEET. The line of Cutter's Advanced products is an example (

However, based on the published scientific research some of these products contain questionably small amounts of picaridin, e.g., Cutter Advanced Picaridin Repel at 7%, Cutter Advanced Wipes at 5.75%. It is therefore recommended that a product like Cutter Advanced Aerosol with 15% picaridin be used. Some repellants available in foreign venues contain even higher concentrations of the chemical.

(4) Avoid scented toiletries and perfumes;

(5) Upon arrival, treat your room with a bug bomb such as Shelltox or Fish (stay outside while this is being done). Touch up with spray after that as needed."

As regards chemoprophylaxis for malaria, Malarone (atovaquone/proguanil)( is likely the best choice if your travel clinic recommends it.

BTW,  Lariam (mefloquine) is an effective and often prescribed antimalarial, but it can pose problems, especially for the diver.   The following updated article from my "Ask RSD" article on the topic in Rodale's Scuba Diving may prove informative:

"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid and disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness.

The US package insert directs that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS.

Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.

Of most concern to the diver are the positions of some medical professionals that the drug simply should not be taken for malaria prophylaxis by those who are actively diving. These sources include Rodale's Diving Doc," Dr. Samuel Shelanski, and the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.

The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction.

The FDA has come out with the following warning regarding mefloquine:


The following is very thorough--The Journal of the American Medical Association (Vol. 297 No. 20, May 23/30, 2007) ( scroll down to the section on Lariam)




This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Diver Rick

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Re: Malaria and Meds
« Reply #2 on: March 23, 2009, 22:08:16 UTC »
Hey Doc.

Extremely useful information.  Thanks for putting that together for me.

I have an excellent Travel Doctor, who has offered Malarone....  I am still not 100% decided if I will take it for the dive resort I am going to (Wakatobi) however I probably will just in case, since the chance of, and nature of the side effects with Malarone are minimal.

Thanks again for the info.

For you and anyone else interested, my travel doctor has a great website with tons of information about this and other travel health issues:  His FAQ's page has some great info in on it.

Best Regards, and thanks again.


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