Q: In September, we are travelling to Borneo. Can you advise which anti-malarial medication is required? We are worried that Lariam has caused side effects when taken before.
Jo Taylor
Dr Jules Eden replies: You have a choice of three antimalarials for Borneo. Lariam, or mefloquine, is one, but if you have experienced side effects before, then steer clear of it this time. Often with this medication, people get bad dreams, anxiety and depression. I advise a test dose before you travel. So that leaves Doxycycline and Malarone. Choose the latter, as you only have to take it for a week after your return. It's four weeks for the doxycycline, which is a bore. Malarone, a daily tablet, is effective. And as it's so new, there is little resistance to it worldwide.
Q: We are planning to travel around India and are concerned about the implications of a full bout of Delhi belly on my husband, who is an insulin-dependent diabetic. How do we maintain a stable blood sugar during a prolonged bout of diarrhoea?
Cheryl & John Ewan
A: Your husband must take his blood sugar testing kit with him. If he gets a bad bout of diarrohea, his blood sugar can dramatically fall to low enough levels to bring on a hypoglycaemic attack. This is where the diabetic gets initially angry and irritable, lapsing into tiredness and potentially a coma. You must be aware of these symptoms as well, in case he fails to recognise the problem.
Take rehydration sachets, such as Dioralyte or Electrolade, with you. If he experiences problems, monitor his blood glucose every hour or two and use the sachets to keep his sugar stable. I would also take a course of the antibiotic ciproxin with you. If he gets loose bowels, take a 750mg dose as a one-off. This will often stop the diarrohea in a day. Get a script from your GP for this.
Finally, make sure he has a doctor's letter explaining his condition, as the local police can take a dim view of travellers carrying syringes and needles.
Q: Last year, I was bitten by a wasp and had a very bad reaction - the treatment at the hospital and from a GP took ages to reduce the swelling. All I have from my GP are some slightly strong anti-histamines to take should I get bitten in the future. I read with horror about someone dying from a wasp sting and wonder whether I should take one of those adrenalin packs with me when I am travelling?
Jane Linklater
A: The first sting sensitises you, creating a mass of antibodies. The next time it happens, a huge allergic reaction can occur, and yes, some people have died as a consequence. However, this is a remote possibility. The best thing is to use the antihistamines as a first defence after a sting. But have an adrenalin pen, too. If you find yourself getting short of breath after a sting, seek medical attention, but if you are in the wilds, use the pen. You need a script for the pen.
· Dr Jules Eden created E-med as an online support service for anyone who finds themselves a long way from a doctor's surgery. You can get free pre-travel information on any destination in the world. Log on and click on the Travel Clinic icon.
