Rodrigo Chaturaka, Rajapakse Senaka, Fernando Sumadhya Deepika
Department of Pathology, School of Medical Sciences, UNSW, Sydney, NSW, Australia.
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Patient Prefer Adherence. 2020 Nov 9;14:2215-2223. doi: 10.2147/PPA.S255561. eCollection 2020.
Chemoprophylaxis is an effective tool for individuals to minimize their risk of contracting malaria and serves an important public health role in preventing imported malaria. Yet, it is only effective if the traveller is fully compliant with the prescribed regimen. For many destinations, a choice of prophylactic agents is available, so historical compliance data can be helpful for both physicians and travellers to make an informed decision.
We analyzed the historical self-reported compliance data for six chemoprophylactic agents currently recommended by CDC for primary malaria chemoprophylaxis by searching PubMed, Embase, CINAHL, Web of Science, and Scopus for observational studies reporting on travelers within the last 25 years. The quality of data was graded as "good" or "poor" using the NIH quality assessment tool for cohort and cross-sectional studies. Cumulative compliance data were compiled for all studies (gross compliance) and the subgroup of studies with "good" quality evidence (refined compliance). Subgroup analyses were performed for weekly vs daily administered regimens, between military and civilian travelers, and across each prophylactic agent.
Twenty-four eligible studies assessed compliance for mefloquine (n=20), atovaquone-proguanil (n=11), doxycycline (n=13), and chloroquine (n=3). No studies were found for primaquine or tafenoquine. Both gross and refined compliance were significantly better for weekly regimens than daily regimens (<0.0001). Stopping chemoprophylaxis due to adverse events was significantly more for doxycycline (<0.0001) compared to other drugs. Compliance was significantly worse in military travelers, but they were also more likely to be prescribed doxycycline.
Malaria chemoprophylaxis for a traveler should depend on prevailing resistance patterns at destination, current national guidelines, and patient preferences. However, when there is a choice, historical compliance data are useful to select a regimen that the traveler is more likely to comply with.
化学预防是个人将感染疟疾风险降至最低的有效工具，在预防输入性疟疾方面发挥着重要的公共卫生作用。然而，只有旅行者完全遵守规定的方案，它才有效。对于许多目的地，有多种预防药物可供选择，因此历史依从性数据有助于医生和旅行者做出明智的决定。
我们通过在PubMed、Embase、CINAHL、Web of Science和Scopus中搜索过去25年内报告旅行者情况的观察性研究，分析了美国疾病控制与预防中心（CDC）目前推荐用于主要疟疾化学预防的六种化学预防药物的历史自我报告依从性数据。使用美国国立卫生研究院（NIH）队列研究和横断面研究质量评估工具将数据质量评为“好”或“差”。汇总所有研究的累积依从性数据（总依从性）以及具有“良好”质量证据的研究亚组（精确依从性）。对每周给药方案与每日给药方案、军事旅行者与平民旅行者以及每种预防药物进行亚组分析。
24项符合条件的研究评估了甲氟喹（n = 20）、阿托伐醌 - 氯胍（n = 11）、多西环素（n = 13）和氯喹（n = 3）的依从性。未找到关于伯氨喹或他非诺喹的研究。每周给药方案的总依从性和精确依从性均显著优于每日给药方案（<0.0001）。与其他药物相比，多西环素因不良事件而停止化学预防的情况显著更多（<0.0001）。军事旅行者的依从性显著更差，但他们也更有可能被开多西环素。
旅行者的疟疾化学预防应取决于目的地流行的耐药模式、现行国家指南和患者偏好。然而，当有选择时，历史依从性数据有助于选择旅行者更可能遵守的方案。
