The Great Malaria Debate

A letter in a 1993 issue of the respected British medical journal The Lancet warned readers about the often severe side effects of mefloquine (better known by its trade name, Lariam). The author of that letter, B. Meredith Burke, Ph.D., read the discussions of malaria and Lariam in recent issues of In Depth and Undercurrent and contacted us. Since Burke's letter describing his personal experience was published in The Lancet, he has been contacted by others who have had similar problems with Lariam. A professional underwater photographer experienced several months of "severe neuropsychiatric symptoms" upon returning from a trip to the South Seas; a physician suffered eight months of limb numbness, vascular problems, and insomnia after taking this drug.

We recently learned that the incidence of serious side effects from this antimalarial seems to be much higher than previously thought. We have also heard from subscribers who have suffered these ill effects. One reader wrote that after taking his first pills he suffered nightmares, a racing heart, and depression; his wife stopped sleeping completely after her first dose.

Burke has also been contacted by a U.K.-based group called Lariam Action, which is planning a legal action against Lariam manufacturer Hoffmann La Roche. The group was started by Lance Cole, a 34-year-old British journalist who experienced mysterious symptoms upon returning from assignment in Zimbabwe -- symptoms that were finally diagnosed as being caused by Lariam. Indeed, after an article in the British Medical Journal reported sharply higher estimates of the incidence of serious side effects, the drug's information sheet has been revised to reflect this fact. What kind of increase? An incredible leap from 1 in 10,000 to 1 in 140!

False Bends

As we reported in "The Big Chill" (In Depth, August 1996), many U.S. doctors now prescribe Lariam as the antimalarial of choice in parts of the world that have chloroquine-resistant strains of Plasmodium falciparum, the most dangerous form of malaria. But many divers avoid taking mefloquine because its side effects may mimic decompression sickness or even malaria itself. However, in a phone conversation with Dr. Hans Lobel, senior malariologist at the Center for Disease Control and Prevention (CDC) in Atlanta, he dismisses the notion that Lariam can mimic the bends as "a rumor going around the diving world."

Damned If You Do, Damned If You Don't

Where chloroquine-resistant strains do exist, the best bet for divers may be doxycycline (vibramycin), a tetracycline-type antibiotic that the CDC recommends as an alternative to mefloquine. Doxycycline is effective against most strains of malaria, but it can greatly increase light sensitivity in some people -- a serious problem in the tropics.

In parts of the world where chloroquine-resistant strains of malaria don't exist (actually a significant part of the far Pacific), chloroquine may be the diver's best antimalarial. But this drug may cause problems, too, as reader M. Sorrell (Old Bridge, New Jersey) writes:

"I traveled to Papua New Guinea, and according to recommendations by the CDC, I talked to my doctor about a malaria preventative. He was interested enough to do some brief research, and prescribed Aralen (chloroquine). This was partially because Lariam's side effects are similar to decompression sickness.

"The Aralen prescription, like others, was to be taken weekly for several weeks after the trip. I experienced no problems the first few weeks; however, within four or five weeks of taking the medication, I had constant stomach and intestinal problems and approximately one-fourth of my hair fell out (it hasn't grown back). Also, almost overnight, I became so extremely lactose intolerant that I can't look at dairy food anymore (I never had this problem before). No one wants malaria, but travelers should be advised this stuff is hard on the body."

It's true that chloroquine can have some unpleasant side effects, including stomach problems, vomiting, dizziness, and headaches. But Dr. Lobel of the CDC says these problems are both minor and very rare (I'm not sure I would not consider losing one-fourth of what hair I have left as minor). He says that several studies have indicated little difference between the side effects of chloroquine and a placebo.

The Debate Continues

The CDC still recommends Lariam for chloroquine-resistant areas , but we are hearing about a lot of serious side effects from this drug. A significant number of people in the dive industry also believe the side effects of Lariam mimic the symptoms of the bends, increasing the chances of misdiagnosis. The CDC does not agree.

The Surgeon General of the Australian Defense Force recommends doxycycline for short visits to places like PNG (and chloroquine for longer stays). However, doxycycline causes excessive sensitivity to the sun.

CDC likes chloroquine for nonresistant areas but warns that taking chloroquine in areas where malaria is chloroquine-resistant will increase your risk of getting the worst kind of malaria. As reader M. Sorrell reminds us, it's not without its own side effects.

The debate on how to avoid malaria rages on. Each antimalarial carries its own set of risks, but we must keep in mind that the disease can be debilitating, even fatal. If you do take a antimalarial, keep a list of the possible side effects with you and be prepared to seek medical advice immediately. In addition to side effects, questions have been raised about the effectiveness of these drugs, so even if you're taking one, try to keep the little buggers at bay by using repellents and nets.

For more information, you can contact Lariam Action by writing Mr. Lance Cole, 9 Prospect Hill, Old Town, Swindon, Wiltshire SN1 3JU, United Kingdom, or, in Berkeley, California,, Susan G. Rose, J.D., 415-393-0700 or e-mail sroseat@aol.com.