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Adherence to Atovaquone-Proguanil Malaria Prophylaxis
Traveler-reported adherence was high; adverse effects were uncommon.
Most cases of malaria in travelers are the result of not receiving an appropriate chemoprophylactic agent or not taking it as prescribed — i.e., before, during, and after travel. Just how common is nonadherence?
To explore this question, investigators at a New York travel clinic conducted a prospective, nonblinded study among travelers aged 
18 who received prescriptions for prophylactic atovaquone-proguanil from July 2008 through December 2008. Participants were interviewed by telephone within 3 weeks after they returned from travel. Among the 124 enrollees, 104 (84%) completed the interview. Participants had a mean age of 56 and 53% were female; the mean trip duration was 12 days. Forty percent traveled to sub-Saharan Africa.
Overall, 89% of study participants reported complete adherence to the prescribed regimen. No travelers to sub-Saharan Africa discontinued the drug. Among those with travel to other destinations, 12 did not complete the course: 3 reported adverse effects, 2 said they were told by tour guides that they did not need prophylaxis, and 7 believed the medication was unnecessary.
Comment: Unlike most other chemoprophylactic agents, which must be taken for 4 weeks after return from travel, atovaquone-proguanil must be taken for only 7 days after return. At present, this preparation can still be used in areas with mefloquine-resistant parasites. Although many studies have found it to be safe and effective, little is known about adherence.
This study is limited by its small size and reliance on self-reported compliance. Nonetheless, the findings provide some reassurance that most travelers, especially those going to the highest-risk destinations (sub-Saharan Africa), complete the medication course.
Published in Journal Watch Infectious Diseases July 28, 2010
Citation(s):
DePetrillo JC et al. Assessment of adherence to atovaquone-proguanil prophylaxis in travelers. J Travel Med 2010 Jul/Aug; 17:217.
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