Current Status and Replies to Frequently Posed Questions on Atovaquone Plus Proguanil (Malarone® ) for the Prevention of Malaria
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Each year at least 30 000 Western travellers acquire malaria and approximately 1–4% of those who acquire Plasmodium falciparum malaria will die as a result of infection. Almost all cases and fatalities are preventable with the use of measures to reduce mosquito bites and appropriate chemoprophylaxis for those at high risk of infection. There are currently a limited number of licensed drugs available to prevent malaria in travellers. New effective and well tolerated agents are urgently needed because of increasing resistance to antimalarials such as chloroquine and proguanil, and real and perceived intolerance to standard drugs such as mefloquine. A newly licensed antimalarial (atovaquone plus proguanil; Malarone®1) compares favourably with other drug options, although some prescribers may be unfamiliar with the specific advantages and disadvantages of this antimalarial. This article reviews recent clinical experience and randomised controlled trial data in order to address frequently asked questions about this new combination drug.
This work was supported by the Canadian Institutes of Health Research (CIHR, MT-13721). K.C. Kain is supported by a Career Scientist Award from the Ontario Ministry of Health and a Canada Research Chair (CIHR). K.C. Kain is on the CME Speakers Bureau for GlaxoSmithKline, Pfizer and Roche.
- 1.World Health Organization (WHO). The world report 1999: making a difference. Geneva: WHO, 1999Google Scholar
- 3.Kain KC. Prophylactic drugs for malaria: why do we need another one? J Travel Med 1999; 6Suppl. 1: S2–7Google Scholar
- 8.Miihlberger N, Jelinek T, Behrens RH, et al. Age is a risk factor for severe manifestations and fatal outcome in European patients with falciparum malaria: observations from TropNetEurop- and SIMPID-surveillance data [abstract MOP5002]. Program and abstracts of the 3rd European Conference on Tropical Medicine and International Health. Acta Tropica 2002; 83: 531Google Scholar
- 9.Centers for Disease Control and Prevention (CDC). Health information for international travel: 2001–2002. Atlanta: US Department of Health and Human Services, 2001Google Scholar
- 10.Canadian recommendations for the prevention and treatment of malaria among international travellers. Committee to Advise on Tropical Medicine and Travel (CATMAT), Laboratory for Disease Control. Can Commun Dis Rep 2000; 26Suppl. 2: i–vi, 1-42Google Scholar
- 11.World Health Organization (WHO). International travel and health 2002. Geneva: WHO, 2002Google Scholar
- 24.Beerahee M, Clarke P, Overbosch D, et al. Prophylaxis with Malarone (atovaquone and proguanil hydrochloride) in non-immune subjects 65 years age and older. Proceedings of the Third European Congress on Tropical Medicine and International Health; 2002 Sep 8–11; Lisbon, PortugalGoogle Scholar
- 25.Product Information. Malarone brand of atovaquone and proguanil hydrochloride tablets. Research Triangle Park: GlaxoSmithKline, 2002Google Scholar
- 35.Nasveld PE, Edstein MD, Kitchener SJ, et al. Comparison of the effectiveness of atovaquone/proguanil combination and doxycycline in the chemoprophylaxis of malaria in Australian Defence Force personnel [abstract 16]. Program and abstracts of the 49th Annual Meeting of the American Society of Tropical Medicine and Hygiene; 2002 Oct 29–Nov 2; Houston, Texas: 139Google Scholar
- 36.Camus D, Malvy D, Schilthuis H, et al. Atovaquone/proguanil versus chloroquine/proguanil or mefloquine in clinical trials of non-immune paediatric travellers 11–40kg. Proceedings of the Third European Congress on Tropical Medicine and International Health; 2002 Sep 8–11; Lisbon, PortugalGoogle Scholar
- 41.Schwartz E, Bujanover S, Kain KC. Genetic confirmation of Atovaquone-proguanil (Malarone™) resistant Plasmodium falciparum malaria acquired by a non-immune traveler to East Africa. Clin Infect Dis 2003. In pressGoogle Scholar
- 42.Schlagenhauf P, Tschopp A, Johnson R, et al. Randomised, double-blind, fourarm study of the adverse event profiles of malaria chemoprophylaxis in non-immune travelers to sub-Saharan Africa [abstract 568]. Am J Trop Med Hyg 2002; 67: 354–5Google Scholar