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Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options.
Clin Infect Dis. 2018 05 17; 66(11):1751-1755.CI

Abstract

Background

Atovaquone-proguanil is considered causal prophylaxis (inhibition of liver-stage schizonts) for Plasmodium falciparum; however, its causal prophylactic efficacy for Plasmodium vivax is not known. Travelers returning to nonendemic areas provide a unique opportunity to study P. vivax prophylaxis.

Methods

In a retrospective observational study, for 11 years, Israeli rafters who had traveled to the Omo River in Ethiopia, a highly malaria-endemic area, were followed for at least 1 year after their return. Malaria prophylaxis used during this period included mefloquine, doxycycline, primaquine, and atovaquone-proguanil. Prophylaxis failure was divided into early (within a month of exposure) and late malaria.

Results

Two hundred fifty-two travelers were included in the study. Sixty-two (24.6%) travelers developed malaria, 56 (91.9%) caused by P. vivax, with 54 (87.1%) cases considered as late malaria. Among travelers using atovaquone-proguanil, there were no cases of early P. falciparum or P. vivax malaria. However, 50.0% of atovaquone-proguanil users developed late vivax malaria, as did 46.5% and 43.5% of mefloquine and doxycycline users, respectively; only 2 (1.4%) primaquine users developed late malaria (P < .0001).

Conclusions

Short-course atovaquone-proguanil appears to provide causal (liver schizont stage) prophylaxis for P. vivax, but is ineffective against late, hypnozoite reactivation-related attacks. These findings suggest that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax.

Authors+Show Affiliations

Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel. Department of Medicine C, Tel Hashomer, Israel.Infectious Diseases Unit, The Sheba Medical Center, Tel Hashomer, Israel. Sackler School of Medicine, Tel Aviv University, Israel.Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel. Department of Medicine C, Tel Hashomer, Israel. Sackler School of Medicine, Tel Aviv University, Israel.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29228132

Citation

Meltzer, Eyal, et al. "Vivax Malaria Chemoprophylaxis: the Role of Atovaquone-Proguanil Compared to Other Options." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 66, no. 11, 2018, pp. 1751-1755.
Meltzer E, Rahav G, Schwartz E. Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options. Clin Infect Dis. 2018;66(11):1751-1755.
Meltzer, E., Rahav, G., & Schwartz, E. (2018). Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 66(11), 1751-1755. https://doi.org/10.1093/cid/cix1077
Meltzer E, Rahav G, Schwartz E. Vivax Malaria Chemoprophylaxis: the Role of Atovaquone-Proguanil Compared to Other Options. Clin Infect Dis. 2018 05 17;66(11):1751-1755. PubMed PMID: 29228132.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options. AU - Meltzer,Eyal, AU - Rahav,Galia, AU - Schwartz,Eli, PY - 2017/10/09/received PY - 2017/12/04/accepted PY - 2017/12/12/pubmed PY - 2019/10/17/medline PY - 2017/12/12/entrez SP - 1751 EP - 1755 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 66 IS - 11 N2 - Background: Atovaquone-proguanil is considered causal prophylaxis (inhibition of liver-stage schizonts) for Plasmodium falciparum; however, its causal prophylactic efficacy for Plasmodium vivax is not known. Travelers returning to nonendemic areas provide a unique opportunity to study P. vivax prophylaxis. Methods: In a retrospective observational study, for 11 years, Israeli rafters who had traveled to the Omo River in Ethiopia, a highly malaria-endemic area, were followed for at least 1 year after their return. Malaria prophylaxis used during this period included mefloquine, doxycycline, primaquine, and atovaquone-proguanil. Prophylaxis failure was divided into early (within a month of exposure) and late malaria. Results: Two hundred fifty-two travelers were included in the study. Sixty-two (24.6%) travelers developed malaria, 56 (91.9%) caused by P. vivax, with 54 (87.1%) cases considered as late malaria. Among travelers using atovaquone-proguanil, there were no cases of early P. falciparum or P. vivax malaria. However, 50.0% of atovaquone-proguanil users developed late vivax malaria, as did 46.5% and 43.5% of mefloquine and doxycycline users, respectively; only 2 (1.4%) primaquine users developed late malaria (P < .0001). Conclusions: Short-course atovaquone-proguanil appears to provide causal (liver schizont stage) prophylaxis for P. vivax, but is ineffective against late, hypnozoite reactivation-related attacks. These findings suggest that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/29228132/Vivax_Malaria_Chemoprophylaxis:_The_Role_of_Atovaquone_Proguanil_Compared_to_Other_Options_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cix1077 DB - PRIME DP - Unbound Medicine ER -