Drug-free holidays: Compliance, tolerability, and acceptability of a 3-day atovaquone/proguanil schedule for pre-travel malaria chemoprophylaxis in Australian travellers
Date
2018
Authors
Lau, Colleen
Ramsey, Lani
Mills, Laura
Furuya-Kanamori, Luis
Mills, Deborah
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Oxford University Press
Abstract
Background
Poor compliance with chemoprophylaxis is a major contributing factor to the risk of malaria in travellers. Pre-travel chemoprophylaxis may improve compliance by enabling ‘drug-free holidays’. The standard treatment dose of atovaquone/proguanil (250mg/100mg, 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.
Methods
233 participants were recruited from four specialised travel medicine clinics in Australia. Adults travelling 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 one 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. The study was registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12616000640404
Results
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 day. 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%).
Conclusions
The 3-day atovaquone/proguanil schedule had an impressively high compliance rate, and was well tolerated and accepted by travellers. Further studies are required to assess the effectiveness of this schedule for chemoprophylaxis in travellers.
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Clinical Infectious Diseases
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Journal article
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Open Access
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