I've been told by my pharmacist that Coartem is not available in UK and the only way to go is to take prophylaxis. Has anybody been able to get hold of it?

In the UK this is known as Riatem. I have just managed to get a private prescription. It is very expensive here, much cheaper using the Canadian on line pharmacies.

Hi,
Are you going to Africa? Cheap and plentiful supply available in most large towns. As you are going to use it as a treatment, it's not required to get it before travel as you will not display symptoms for some time after infection, which will give you time to buy locally. I swear by this kind :
If you've had malaria before, you'll recognise the symptoms and you should start the course as soon as possible, don't forget to finish the whole treatment.
CJ.

Lordy, not another bloody malaria thread......

CoArtem will be available in the UK but no-one is going to prescribe it for you unless you actually have malaria.....

The strategy of waiting until you get malaria and then treating it with locally sourced cheap drugs that cost a lot in the first world could get you killed.

You may wish to research previous threads on this subject.

Thanks for your input Doc. For those of us who live in Africa taking prophylactics 365 days of the year is not feasible nor healthy. Therefor taking measures to prevent being bitten are just as important as having a cure close at hand when infected.

The strategy of of waiting until you get malaria and then treating it with locally sourced cheap drugs that cost a lot in the first world is exactly what 99% of Africas population does (that is my made up figure by the way, most likely not exactly correct).

I have read through previous malaria threads here on the HUBB and there is a lot of helpful info and also a lot of bunkum scaremongering. For many the posts regarding malaria here are confusing and conflicting, however, the OP asked about where to get a hold of Coartem. I gave a tip and advice for a product that I have used to successfully treat previous bouts of malaria. It is made by Novartis under license in the PRC.

Novartis Malaria Initiative: Home

If a post offends you mate, you are welcome not to read it. Likewise your condescending attitude is not appreciated, although it seems thats your style.

You may wish to read the available research on fraudulent drug manufacture and sale in Africa and which drugs are usually involved.

You may wish to consider that indigenous Africans have a degree of natural immunity to malaria that visitors do not and that a strategy that works for them may result in the death of a visitor, even if the local drugs are genuine, but about 40% of the time, they are not.

I haven't seen much scaremongering on the HUBB, but I have seen a lot of bunkum of the ilk that you peddle as in your post below; malaria kills a lot of people and the misinformation that you propagate can add to that.

I usually state facts in my posts, of two sorts:

1. The recognized current prophylaxis and treatment approach for travelers with respect to malaria.
2. The evidence based risk of relying on drugs bought in the third world. Note the use of the word risk, rather than certainty.

I'm not sure why you would feel that stating facts is condescending, but I am sure that I really don't care what you think either - you're just another guy who lives in Africa: the sky is blue, grass is green and malaria and the drugs issues are what they are.

One pays one's money and one takes one's choice, but I offer to all readers the opinion that waiting to get malaria and then treating it using local drugs is not at all a good idea and that visitors to malarious areas would be well advised to practice bite avoidance together with regular drug prophylaxis using drugs sourced from a reliable and reputable pharmacy.

Let's try to maintain a focus on the issue--malaria prophylaxis and treatment--and tone down the personal attacks. Right?

+1.

Sorry markhaf,
I'll stick to facts:

Malaria kills people. However over 75% of such deaths are children under the age of 5 who have not yet developed a mature immune system.

Pregnant mums are also at risk due to the fact that being pregnant depletes their immune system as well.

Malaria Overview | Doctors Without Borders

Cheap locally sourced drugs are the way forward:

Hosted by the Global Fund and known as the Affordable Medicines Facility - malaria (AMFm), is to make ACT medication as widely and cheaply accessible as possible. The initiative, launched last year in eight countries -- Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, Uganda and Cambodia -- is financially supported by UNITAID, the United Kingdom and the Bill and Melinda Gates Foundation, and receives technical support from members of the Roll Back Malaria (RBM) Partnership.

Source: Huffington Post:

Michel D. Kazatchkine: Cheaper Drugs are Spearheading the Fight Against Malaria

Personal experiences:

I'm not a indigenous African however I've been living in sub Saharan Africa (both East and West) since 2006.

Having worked in a medical programme in Sierra Leone (albeit not as a medical staff) our experience was that in the occasions adults died of malaria related conditions there were in most cases co-infections, ill health due to malnourishment or the patient presented too late to the hospital.

Having said that, there is a health risk associated with malaria. However we need to put that risk in perspective. Since 2006, I know of 1 visitor to Sth Sudan who contracted P. falciparum which ultimately put him in a coma. By unfortunate happenstance, he presented late to a hospital back in France as symptoms occurred just as he started his travel back to Europe giving the merozoites in the liver time to reproduce.

Likewise the same delay of treatment in my own experience with the Plasmodium falciparum form of the disease. I was incorrectly given a negative result for it at the Aga Khan clinic in Nairobi. Less than 48 hours later I was back at the Aga Khan hospital on an intravenous drip.

In the same time period since 2006, dozens of my colleagues have been killed/injured in road traffic accidents, which in my belief is the real health risk faced by users of this website and should be our focus. In fact, in my circle of colleagues and friends both expat and African, I know of more people killed by landmines than malaria. LM = 2, Malaria = 0.

I am not pedaling misinformation, I assumed the OP had made a decision based on his understanding of the situation. What I have recommended here is a product I have used and found it effective.

My advice given here will not propagate further malaria deaths, as under 5's and pregnant mums in Sub Saharan Africa are not big users of this forum. Apologies if they are.

Granted, malaria sucks and is best avoided. Bite avoidance is paramount and by all means take prophylaxis, however as a healthy adult contracting malaria will not mean you will have it for life and you will die a horrible, painful, sweaty death. Most likely you will feel crappy for a couple days and tired for some days after that. Provided you start a course of ACT based treatment as early as possible.

That is my experiencs as just another guy in Africa, living in a malaria endemic zone with first hand experience with the disease.
CJ.

A few more facts.

There is clear guidance for malaria naive travelers on both the CDC and WHO websites as well as the usual UK government sites.

NONE of them concur with CamJohnson's opinion and strongly recommend appropriate prophylaxis rather than treat when you get sick with local drugs. Some local drugs are genuine, some are not - depends where you get 'em.

Our military personnel took appropriate prophylaxis indefinitely with no problems despite the license restrictions. So did I.

There are forms of malaria that will stay with you for life unless you get appropriate treatment.

Falciparum can kill you quickly even if you have been taking prophylaxis.

COI: formally trained in Tropical Medicine, lived and worked in the tropics including all malarious areas treating various tropical infections. I would have thought that working with a medical NGO you would be aware of CDC and WHO prophylaxis and treatment guidelines. Your n=2 study is irrelevant. Come back with n=6000.

Insinuating that a new traveler to Africa can do what the locals do and fare as well is dangerously untrue and utterly irresponsible IMHO. I challenge you to find a qualified physician who agrees with you.

I will not be offering further comments on this thread.

Let's start our with the self-evident observation that it is perfectly possible for reasonable people to examine identical evidence and draw differing conclusions.

The approach Cam Johnson is describing is quite common among long-term ex-pat residents in Africa and elsewhere. That does not make it the correct or the only valid approach--I'm merely pointing out that it's commonly done. Note that I'm not discussing locals, who have some genetic and environmental advantages (should they survive to adulthood) when it comes to malaria.

It's not my approach. I take Malarone almost everywhere these days, occasionally lapsing into mefloquine. However, I do recommend carrying a course of Coartem whether using other anti-malarials or not; it's not unusual to contract malaria regardless, and it's handy to have the cure on hand when, as has happened to me, you suddenly collapse into helplessness. Onset of acute malaria can be rapid. Counting on a slow onset, as was suggested in a previous post, seems to me unwise at best.

There are indeed a lot of counterfeit and adulterated medications sold in Africa, and it's probably worth going to a certain amount of trouble to get the genuine stuff if you can. I buy Coartem in Africa only because it's not available in the USA. Other important meds I purchase here at home. Less critical supplies (tetracyclines, fluoroquinolones, nitroimidazoles) I often purchase in the Developing World, where they are far cheaper.

FWIW, my own doctor, who is not prone to risk-taking or impulsive decisions, has chosen not to take anti-malarials while in malarial zones. So have other medical professionals with whom I've been acquainted. Note that I'm not claiming to believe this is a good idea: I'm just reporting the facts.

It's an emotional subject, and I've been known to get carried away in past discussions--in part because I've nearly died of the disease, and have put a lot of effort into learning more about it and to informing others. I've slowly discovered that, if the goal is to teach and inform, a calm manner seems to work best.

Caveat: I'm not a medical professional. I'm an ex-ditchdigger who happens to pay close attention to certain things.

Mark

Sorry I was unclear earlier due to a rapid posting that I didn't think I was going to get flamed for. I was not suggesting that malaria symptoms come on slowly, in fact they can manifest themselves in exactly the length of time it takes a get taxi to get from Nairobi town to Jomo Kenyatta Airport when there is no traffic, as was the case with me. About 30 minutes.

What I was trying to say was even if you are bitten the moment you step off the aircraft or pass into an endemic area, the incubation period is at least 7-10 days meaning you will not be aware of the parasite in your system and will not display symptoms.

Since the good docsherlock has given me the last word I'm going to put things in brief form, besides there are probably only 3 people reading this thread anyway by now.

Put it this way. I know many healthy adults here in Africa and I would hazard a guess that they have all had malaria several times since I've known them. They've all been sick from it (in varying degrees from mild to comatose). None of them died. That might not be n=6000, but you get my point.

Lets wait and see if there are further legal actions from military personnel who have made compensatory claims relating to compulsory Lariam usage. Additionally, the statistical likelihood of maintaining a daily or weekly regime of prophylaxis is lessened in the daily bustle of everyday life.

Docsherlock, you have stated that there are forms of malaria that will remain in your system if left untreated. If you suspect you have malaria in your system go for treatment. I would of thought that to be self evident.

Counterfeit drugs exist, I'm not denying that. You can also find reputable chemists in Africa and I suggest not buying this kind of medication in the local market from a guy with a portable table.

Quotation: "Insinuating that a new traveler to Africa can do what the locals do and fare as well is dangerously untrue and utterly irresponsible IMHO." Where did I do that mate? My response was to a specific question. Further responses were anecdotal based on African residents experience.

I have stated a number of times that by all means use prophylaxis and it will help in avoiding infection. But that is not the only strategy in use. Again in my original post I simply made a recommendation to the OP (who has probably gone on to more interesting threads rather than watch me and docsherlock knockheads over this issue). We don't know if he is using prophylaxis in the same manner as markhaf.

What I do agree with you docsherlock is that we make our choices. We ride bikes, I ride mine in Africa. That alone would put me in the 'must be a mental case basket' for many people. Add to that I don't take malaria prophylaxis (for what its worth there is a reason apart from me being obviously irresponsible and a danger to others. I can't sleep at all using Lariam and will forget daily dosages). I never poo pooed recommendations however I've worked with qualified physicians who agreed with me and did the same.

I'm happy to answer any questions related to this thread and my comments therein.
CJ.

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