Atovaquone-proguanil in the treatment of imported uncomplicated Plasmodium falciparum malaria: a prospective observational study of 553 cases

Malaria Journal

Research

Pascal Ralaimazava¹  Hugues Cordel²  Olivier Bouchaud²  Johann Cailhol²  Sophie Matheron³  Pauline Campa⁴  Olivier Fain⁵  Martine Bloch⁶  Hélène Gros⁷  Patrice Bourée⁸  Nadine Godineau⁹  Paul-Henri Consigny^1,10 

[1] Department of Infectious and Tropical Diseases, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France;Department of Infectious and Tropical Diseases, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France;LEPS EA3412, Université Paris 13 - Sorbonne Paris Cité, Paris, France;Department of Infectious and Tropical Diseases, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France;Department of Infectious and Tropical Diseases, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France;Department of Internal Medicine, Hôpital Jean verdier, Assistance Publique - Hôpitaux de Paris, Paris, France;Department of Internal Medicine, Hôpital Louis Mourrier, Assistance Publique - Hôpitaux de Paris, Colombes, France;Department of Internal Medicine, Hôpital Robert Ballanger, Aulnay-Sous-Bois, France;Department of Parasitology, Hôpital Bicètre, Assistance Publique - Hôpitaux de Paris, Paris, France;Department of Parasitology, Hôpital Delafontaine, Saint Denis, France;Institut Pasteur, Centre Médical, Paris, France;

关键词: Atovaquone-proguanil;    Imported;    Uncomplicated;    Malaria;    Tolerance;   

DOI  :  10.1186/1475-2875-12-399

 received in 2013-09-04, accepted in 2013-10-30,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundEach year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP’s efficacy and tolerance were evaluated in several trials, its use in “real life” conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas.MethodsBetween September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up.ResultsA total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8% were infected in West Africa, whereas 0.5% were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9% of the patients, the remainder (32.1%) were backpackers. Three-hundred and sixty-four patients (66%) fulfilled follow-up at day 7 and 265 (48%) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77%) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95% [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR.ConclusionThis study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.

【 授权许可】

Unknown   
© Cordel et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.