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Antimalarial prophylaxis--use and adverse events in visitors to the Kruger National Park.
S Afr Med J. 1999 Feb; 89(2):170-5.SA

Abstract

OBJECTIVES

To determine the use of antimalarial prophylaxis and the relative frequency of adverse events with different regimens in visitors to the Kruger National Park.

DESIGN

Retrospective postal survey of a cohort of 7,397 visitors during April 1996. Telephonic interviews were conducted with all respondents who reported neuropsychiatric adverse events necessitating medical attention, and their medical caregivers.

RESULTS

The most commonly used regimens were chloroquine and proguanil in combination (C&P) (35.6%) and mefloquine (18.4%). However, non-recommended regimens were also used by travellers to this chloroquine-resistant area, including chloroquine alone (15.7%). Adverse events were reported by 23.8% of travellers and were more common in the C&P group than the mefloquine group (28.9% v. 25.0%, P = 0.0100). Gastro-intestinal side-effects were significantly more common in the C&P group (nausea (P = 0.0170), diarrhoea (P = 0.0008), mouth ulcers (P = 0.0000)), while neuropsychiatric side-effects were more common in the mefloquine group (depression (P = 0.0000), light-headedness (P = 0.0009), anxiety (P = 0.0060)). Only 30% of travellers reported using antimalarial drugs both regularly as prescribed and for 4 weeks after leaving the malaria area. The most commonly reported reason for changing prophylaxis was advice from a physician or pharmacist (41.9%).

CONCLUSIONS

Health professionals providing medical advice to prospective travellers to malarious areas must tailor recommendations based on the balance between malaria risk in a specific geographical area and the benefits and tolerance of protective measures. Mosquito-avoidance measures should always be advocated, but counselling on antimalarial prophylaxis will be guided by the malaria/prophylaxis (serious adverse events) risk ratio. Where drug measures are indicated, the importance of their correct use should be emphasised.

Authors+Show Affiliations

Communicable Disease Control, Mpumalanga Department of Health, Nelspruit.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10191871

Citation

Durrheim, D N., et al. "Antimalarial Prophylaxis--use and Adverse Events in Visitors to the Kruger National Park." South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, vol. 89, no. 2, 1999, pp. 170-5.
Durrheim DN, Gammon S, Waner S, et al. Antimalarial prophylaxis--use and adverse events in visitors to the Kruger National Park. S Afr Med J. 1999;89(2):170-5.
Durrheim, D. N., Gammon, S., Waner, S., & Braack, L. E. (1999). Antimalarial prophylaxis--use and adverse events in visitors to the Kruger National Park. South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 89(2), 170-5.
Durrheim DN, et al. Antimalarial Prophylaxis--use and Adverse Events in Visitors to the Kruger National Park. S Afr Med J. 1999;89(2):170-5. PubMed PMID: 10191871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antimalarial prophylaxis--use and adverse events in visitors to the Kruger National Park. AU - Durrheim,D N, AU - Gammon,S, AU - Waner,S, AU - Braack,L E, PY - 1999/4/7/pubmed PY - 1999/4/7/medline PY - 1999/4/7/entrez SP - 170 EP - 5 JF - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde JO - S Afr Med J VL - 89 IS - 2 N2 - OBJECTIVES: To determine the use of antimalarial prophylaxis and the relative frequency of adverse events with different regimens in visitors to the Kruger National Park. DESIGN: Retrospective postal survey of a cohort of 7,397 visitors during April 1996. Telephonic interviews were conducted with all respondents who reported neuropsychiatric adverse events necessitating medical attention, and their medical caregivers. RESULTS: The most commonly used regimens were chloroquine and proguanil in combination (C&P) (35.6%) and mefloquine (18.4%). However, non-recommended regimens were also used by travellers to this chloroquine-resistant area, including chloroquine alone (15.7%). Adverse events were reported by 23.8% of travellers and were more common in the C&P group than the mefloquine group (28.9% v. 25.0%, P = 0.0100). Gastro-intestinal side-effects were significantly more common in the C&P group (nausea (P = 0.0170), diarrhoea (P = 0.0008), mouth ulcers (P = 0.0000)), while neuropsychiatric side-effects were more common in the mefloquine group (depression (P = 0.0000), light-headedness (P = 0.0009), anxiety (P = 0.0060)). Only 30% of travellers reported using antimalarial drugs both regularly as prescribed and for 4 weeks after leaving the malaria area. The most commonly reported reason for changing prophylaxis was advice from a physician or pharmacist (41.9%). CONCLUSIONS: Health professionals providing medical advice to prospective travellers to malarious areas must tailor recommendations based on the balance between malaria risk in a specific geographical area and the benefits and tolerance of protective measures. Mosquito-avoidance measures should always be advocated, but counselling on antimalarial prophylaxis will be guided by the malaria/prophylaxis (serious adverse events) risk ratio. Where drug measures are indicated, the importance of their correct use should be emphasised. SN - 0256-9574 UR - https://www.unboundmedicine.com/medline/citation/10191871/Antimalarial_prophylaxis__use_and_adverse_events_in_visitors_to_the_Kruger_National_Park_ DB - PRIME DP - Unbound Medicine ER -