E-DRUG: Malaria prophylaxis

["Steve Toovey" <toovey@iafrica.com>]

E-drug: Malaria prophylaxis (cont.)
-----------------------------------

Thanks to e-druggers who responded to my question on the efficacy of
chloroquine and paludrine. Replies appear to indicate a belief that
mefloquine and doxycycline are more efficacious than chloroquine and
paludrine. There are studies comparing mefloquine with doxycycline,
and mefloquine with the combination, but does anybody have
any evidence, even anecdotal, comparing doxycycline with the
combination? 

The following report is cut from the UK Malaria Reference Centre 
report on the Eurosurveillance website 
http://www.eurosurv.org/main.htm

                     Rise in falciparum malaria imported from east
                     Africa

                     A marked rise in the number of cases of
                     falciparum malaria contracted in east Africa,
                     imported to the United Kingdom (UK) and reported
                     to the Malaria Reference Laboratory, was seen in
                     the first quarter of 1998. One hundred and
                     fifty-four cases were notified, as compared with
                     a mean of 29 cases for the same period in the
                     preceding four years. Two contributory factors
                     are a great increase in malaria transmission due
                     to unusually heavy rains in Kenya and Uganda,
                     which has led to large increases in the incidence
                     of malaria in the indigenous populations, and an
                     increase in the use of chloroquine/proguanil
                     prophylaxis, rather than mefloquine, by short
                     term visitors. Guidelines for travellers from the
                     United Kingdom revised in September 1997 (1)
                     accepted this alternative in view of concern
                     about and unwillingness to take mefloquine but
                     warned of the reduced protection. No data exist
                     on the proportions of visitors taking the
                     different regimens each year, so the relative
                     importance of the two contributory factors cannot
                     be stated. Sixty-eight cases reported in the
                     first quarter of 1998 took no antimalarial
                     chemoprophylaxis, compared with a mean of 16.25
                     in the preceding four years; three took
                     mefloquine compared with 0.5; and 39 took
                     proguanil plus chloroquine, compared with 2.75.
                     The increase in cases was sevenfold among those
                     exposed in Kenya: compared with fourfold among
                     those exposed elsewhere in east Africa. There is
                     also anecdotal evidence of an increase in
                     clinical cases of severe malaria in the UK over
                     this period.

                     These data emphasise the incomplete protection
                     afforded by chloroquine/proguanil, the need for
                     early diagnosis and prompt treatment of any
                     febrile illness, and for action by travellers to
                     reduce the chance of being bitten by mosquitoes
                     between dusk and dawn (1).

                     References:

                        1.Bradley DJ, Warhurst DC, on behalf of an
                        expert
                          group of doctors, nurses, and pharmacists.
                          Guidelines for the prevention of malaria in
                          travellers from the United Kingdom. Commun
                          Dis Rep CDR Rev 1997; 7: R137-52. (
                          http://www.phls.co.uk/cdsc/ ) 

                     Reported by David Bradley (dbradley@lshtm.ac.uk),
                     London School of Hygiene and Tropical Medicine,
                     London, England.



Thanks

Dr Stephen Toovey
Johannesburg
Steve Toovey
Mailto:toovey@iafrica.com 
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