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Effectiveness of twice a week prophylaxis with atovaquone-proguanil (Malarone®) in long-term travellers to West Africa.
J Travel Med. 2016 Jun; 23(6)JT

Abstract

BACKGROUND

Current guidelines recommend daily dosing of atovaquone-proguanil (AP), beginning a day before travel to endemic areas and continuing for 7 days after departure. Adherence of long-term travellers to daily malaria chemoprophylaxis tends to be poor, even when residing in highly endemic malaria regions. Evidence from a volunteer challenging study suggests that non-daily, longer intervals dosing of AP provides effective protection against Plasmodium falciparum This study examines the effectiveness of twice weekly AP prophylaxis in long-term travellers to highly endemic P. falciparum areas in West Africa.

METHODS

An observational surveillance study aimed to detect prophylactic failures associated with twice weekly AP, during the years 2013-2014, among long-term expatriates in two sites in West Africa. The expatriates were divided according to the malaria prophylaxis regimen taken: AP twice weekly; mefloquine once weekly and a group refusing to take prophylaxis. Malaria events were recorded for each group. The incidence-density of malaria was calculated by dividing malaria events per number of person-months at risk.

RESULTS

Among 122 expatriates to West Africa the malaria rates were: 11.7/1000 person-months in the group with no-prophylaxis (n = 63); 2.06/1000 person-months in the 40 expatriates taking mefloquine (P = 0.006) and no cases of malaria (0/391 person-months, P = 0.01) in the twice weekly AP group (n = 33).

CONCLUSIONS

No prophylaxis failures were detected among the group of expatriates taking AP prophylaxis twice weekly compared with 11.7/1000 person-months among the no-prophylaxis group. Twice weekly AP prophylaxis may be an acceptable approach for long-term travellers who are unwilling to adhere to malaria chemoprophylaxis guidelines.

Authors+Show Affiliations

The Infectious Diseases Unit, Shaare-Zedek Medical Center, P.O.B 3235, Jerusalem 91301, Israel lachisht@yahoo.com.The Infectious Diseases Unit, Shaare-Zedek Medical Center, P.O.B 3235, Jerusalem 91301, Israel.Centro Médico La Paz, Malabo, Equatorial Guinea.The Center for Geographic Medicine, the Chaim Sheba Medical Center, Tel-Hashomer, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27625401

Citation

Lachish, Tamar, et al. "Effectiveness of Twice a Week Prophylaxis With Atovaquone-proguanil (Malarone®) in Long-term Travellers to West Africa." Journal of Travel Medicine, vol. 23, no. 6, 2016.
Lachish T, Bar-Meir M, Eisenberg N, et al. Effectiveness of twice a week prophylaxis with atovaquone-proguanil (Malarone®) in long-term travellers to West Africa. J Travel Med. 2016;23(6).
Lachish, T., Bar-Meir, M., Eisenberg, N., & Schwartz, E. (2016). Effectiveness of twice a week prophylaxis with atovaquone-proguanil (Malarone®) in long-term travellers to West Africa. Journal of Travel Medicine, 23(6). https://doi.org/10.1093/jtm/taw064
Lachish T, et al. Effectiveness of Twice a Week Prophylaxis With Atovaquone-proguanil (Malarone®) in Long-term Travellers to West Africa. J Travel Med. 2016;23(6) PubMed PMID: 27625401.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of twice a week prophylaxis with atovaquone-proguanil (Malarone®) in long-term travellers to West Africa. AU - Lachish,Tamar, AU - Bar-Meir,Maskit, AU - Eisenberg,Neta, AU - Schwartz,Eli, Y1 - 2016/09/13/ PY - 2016/07/01/received PY - 2016/08/23/accepted PY - 2016/9/15/entrez PY - 2016/9/15/pubmed PY - 2017/3/16/medline KW - Atovaquone–proguanil KW - expatriates KW - malaria chemoprophylaxis KW - mefloquine KW - travellers JF - Journal of travel medicine JO - J Travel Med VL - 23 IS - 6 N2 - BACKGROUND: Current guidelines recommend daily dosing of atovaquone-proguanil (AP), beginning a day before travel to endemic areas and continuing for 7 days after departure. Adherence of long-term travellers to daily malaria chemoprophylaxis tends to be poor, even when residing in highly endemic malaria regions. Evidence from a volunteer challenging study suggests that non-daily, longer intervals dosing of AP provides effective protection against Plasmodium falciparum This study examines the effectiveness of twice weekly AP prophylaxis in long-term travellers to highly endemic P. falciparum areas in West Africa. METHODS: An observational surveillance study aimed to detect prophylactic failures associated with twice weekly AP, during the years 2013-2014, among long-term expatriates in two sites in West Africa. The expatriates were divided according to the malaria prophylaxis regimen taken: AP twice weekly; mefloquine once weekly and a group refusing to take prophylaxis. Malaria events were recorded for each group. The incidence-density of malaria was calculated by dividing malaria events per number of person-months at risk. RESULTS: Among 122 expatriates to West Africa the malaria rates were: 11.7/1000 person-months in the group with no-prophylaxis (n = 63); 2.06/1000 person-months in the 40 expatriates taking mefloquine (P = 0.006) and no cases of malaria (0/391 person-months, P = 0.01) in the twice weekly AP group (n = 33). CONCLUSIONS: No prophylaxis failures were detected among the group of expatriates taking AP prophylaxis twice weekly compared with 11.7/1000 person-months among the no-prophylaxis group. Twice weekly AP prophylaxis may be an acceptable approach for long-term travellers who are unwilling to adhere to malaria chemoprophylaxis guidelines. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/27625401/Effectiveness_of_twice_a_week_prophylaxis_with_atovaquone_proguanil__Malarone®__in_long_term_travellers_to_West_Africa_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/taw064 DB - PRIME DP - Unbound Medicine ER -