Research School of Population Health, Australian National University, Canberra, Australian Capital Territory.
Dr Deb the Travel Doctor, Travel Medicine Alliance, Brisbane, Queensland.
Clin Infect Dis. 2019 Jun 18;69(1):137-143. doi: 10.1093/cid/ciy854.
Poor compliance with chemoprophylaxis is a major contributing factor to the risk of malaria in travelers. Pre-travel chemoprophylaxis may improve compliance by enabling "drug-free holidays." The standard treatment dose of atovaquone/proguanil (250 mg/100 mg, 4 tablets/day for 3 days) provides protection against malaria for at least 4 weeks, and could therefore potentially be used for pre-travel chemoprophylaxis. In this study, we assessed the compliance, tolerability, and acceptability of the 3-day atovaquone/proguanil schedule for malarial chemoprophylaxis.
Two hundred thirty-three participants were recruited from 4 specialized travel medicine clinics in Australia. Adults traveling to malaria-endemic areas with low/medium risk for ≤4 weeks were enrolled and prescribed the 3-day schedule of atovaquone/proguanil, completed at least 1 day before departure. Questionnaires were used to collect data on demographics, travel destination, medication compliance, side effects, and reasons for choosing the 3-day schedule.
Overall, 97.7% of participants complied with the 3-day schedule. Although side effects were reported in 43.3% of the participants, these were well tolerated, and mainly occurred during the first and second days. None of the participants developed malaria. The main reasons for choosing the 3-day schedule over standard chemoprophylaxis options were that it was easier to remember (72.1%), required taking fewer tablets (54.0%), and to help scientific research (54.0%).
The 3-day atovaquone/proguanil schedule had an impressively high compliance rate, and was well tolerated and accepted by travelers. Further studies are required to assess the effectiveness of this schedule for chemoprophylaxis in travelers.
ACTRN12616000640404.
旅行者疟疾风险的一个主要因素是药物预防依从性差。旅行前药物预防可通过实现“无药假期”来提高依从性。阿托伐醌/磺胺多辛（250mg/100mg，4 片/天，连用 3 天）的标准治疗剂量可提供至少 4 周的疟疾预防保护，因此可能可用于旅行前药物预防。在这项研究中，我们评估了 3 天阿托伐醌/磺胺多辛方案用于疟疾药物预防的依从性、耐受性和可接受性。
从澳大利亚 4 家专门的旅行医学诊所招募了 233 名参与者。招募前往疟疾低/中度流行地区且旅行时间≤4 周的成年人，并开具 3 天阿托伐醌/磺胺多辛处方，在出发前至少 1 天开始服用。使用问卷收集参与者的人口统计学、旅行目的地、药物依从性、副作用以及选择 3 天方案的原因等数据。
总体而言，97.7%的参与者遵守了 3 天方案。尽管 43.3%的参与者报告出现副作用，但这些副作用耐受良好，主要发生在第 1 天和第 2 天。没有参与者发生疟疾。选择 3 天方案而非标准预防方案的主要原因是：更容易记住（72.1%）、服用的药片更少（54.0%）、有助于科学研究（54.0%）。
3 天阿托伐醌/磺胺多辛方案具有很高的依从率，且旅行者耐受性和接受度良好。需要进一步研究评估该方案在旅行者中的药物预防效果。
ACTRN12616000640404。
