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Malaria Prophylaxis in Patients with Renal Impairment

A Review

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Abstract

Malaria is an endemic and potentially lethal disease transmitted by the protozoan parasite Plasmodium. It is currently endemic in more than 100 countries, which are visited by 125 million international travellers every year. For dialysis and renal insufficiency patients it becomes increasingly easier to travel to these countries thanks to the recent advances in renal replacement therapy. However, the pharmacokinetics of some prophylactic agents in malaria are altered, which may modify the effectiveness and safety of such treatments and the way they should be prescribed. Clinicians should be aware of these alterations which require subsequent dosage adjustments. This review provides recommendations on the use of antimalarial drugs, alone or in combination, in patients with renal impairment. These recommendations depend on the prevalence of Plasmodium falciparum chloroquine resistance, as defined by the WHO. Furthermore, fixed-dose combinations cannot be used in patients with creatinine clearance below 60 mL/min since the tablets available do not allow appropriate dosage adjustment for each drug. Chloroquine and proguanil require dosage adjustments, while atovaquone, doxycycline and mefloquine do not.

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Acknowledgements

Native English editing and manuscript styling was provided by Andrea Bothwell of inScience Communications, a Wolters Kluwer business, with funding by Astellas.

The authors have no conflicts of interest to declare that are directly relevant to this article.

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Authors and Affiliations

  1. Service ICAR Department, Nephrology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Sabine Amet, Sarah Zimner-Rapuch, Vincent Launay-Vacher & Nicolas Janus

  2. Nephrology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Gilbert Deray

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  1. Sabine Amet
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Correspondence to Sabine Amet.

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Amet, S., Zimner-Rapuch, S., Launay-Vacher, V. et al. Malaria Prophylaxis in Patients with Renal Impairment. Drug Saf 36, 83–91 (2013). https://doi.org/10.1007/s40264-013-0017-y

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