Malaria chemoprophylaxis Thailand - 2-3 months

Question: Hello, I will be spending a couple of months in parts of Thailand / Laos that have a malaria risk. As I don't tolerate Doxycycline (gastro problems) and do not want to risk Lariam I was looking for an alternative and found studies that used Azithromycin (loading dose 750mg with daily dose of 250mg - Pubmed link here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161858/ ). I have taken Azithromycin in the past for sinus infections without any side effects and would like to take it as described in the article. I understand I can buy it over the counter (!) in Thailand but would prefer to buy it in the UK from a known supplier. Are you happy to offer a private prescription for this? Thank you.

Answer:We can prescribe malaria medications. Current Guidelines on Malaria Prevention in Travellers from the UK recommend the following Chemoprophylaxis for your area of travel: Doxycycline OR Mefloquine OR Malarone If you do not tolerate doxycycline, Malarone is recommended and has the added benefit of being taken for the shortest period of time minimising the exposure to side effects. Malarone is not licensed for prescription over an extended period of time, so if you are travelling for several months then doxycycline or lariam are advised instead. You should know that there are pockets along the Thai-Burmese and Thai-Cambodian borders where Mefloquine resistant malaria exists, so check your travel plans do not involve travelling to these areas. Doxycycline is a wide-spectrum antibiotic, which works by fighting off bad bacteria. However, taking doxy can kill some of the good gastrointestinal bacteria, and this is easily remedied with a course of probiotics which can be easily found in Boots who do an own brand box of 30 capsules for around £2.99. There is a lot of information on the net, and whilst Pubmed is a trusted archive of research articles the one you cite is actually quite old (2003) - as are others due to Pubmed not requiring paid subscription for access. There may well be resistance to this particular antibiotic in your area of travel or the paper could have been one of many highly experimental ones from this particular period/on this area/group of subjects studied. You simply do not know.