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Fernando SD, Ranaweera D, Weerasena MS, Booso R, Wickramasekara T, Madurapperuma CP, Danansuriya M, Rodrigo C, Herath H. Success of malaria chemoprophylaxis for outbound civil and military travellers in prevention of reintroduction of malaria in Sri Lanka. Int Health 2021; 12:332-338. [PMID: 31927579 PMCID: PMC7322204 DOI: 10.1093/inthealth/ihz094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/03/2019] [Accepted: 12/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sri Lanka was certified as malaria-free in September 2016. However, the continuous presence of the malaria vector poses serious risks of reintroduction of the disease. Chemoprophylaxis and advice on malaria preventive behaviour for international travellers is a key strategy adopted to reduce the risk of imported malaria. METHODS We conducted an efficiency study of malaria chemoprophylaxis for civilian and military travellers who requested travel advice from the Anti Malaria Campaign (AMC) prior to departure. The AMC is the only agency that can issue malaria chemoprophylaxis to travellers and hence this sample is representative of all such individuals seeking travel advice in Sri Lanka. RESULTS A total of 544 (400 civilians and 144 military) travellers were interviewed prior to departure and after return. The majority travelled to African destinations (516/544 [94.8%]) and were prescribed mefloquine (517/544 [95%]). Chemoprophylaxis was well tolerated and discontinuation due to adverse events was minimal. Regular chemoprophylaxis was reported by 505 (92.8%) participants while overseas. The protective efficacy of chemoprophylaxis was 100% among those who complied with the full course. CONCLUSIONS The compliance with chemoprophylaxis and its protective efficacy were satisfactory in this study. It is an effective tool in preventing imported malaria to post-elimination Sri Lanka.
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Affiliation(s)
- Sumadhya D Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, PO Box 271, Kynsey Road, Colombo C0008, Sri Lanka
| | - Dewanee Ranaweera
- Anti Malaria Campaign, Ministry of Health, 555/5 Public Health Complex, Narahenpita, Colombo, Sri Lanka
| | - Methnie S Weerasena
- Anti Malaria Campaign, Ministry of Health, 555/5 Public Health Complex, Narahenpita, Colombo, Sri Lanka
| | - Rahuman Booso
- Directorate of Health Services, Sri Lanka Air Force Head Quarters, C0002, Sri Lanka
| | - Thamara Wickramasekara
- Director Preventive Medicine and Mental Health Services, Army Head Quarters C0004, Sri Lanka
| | - Chirath P Madurapperuma
- Department of Parasitology, Faculty of Medicine, University of Colombo, PO Box 271, Kynsey Road, Colombo C0008, Sri Lanka
| | - Manjula Danansuriya
- Anti Malaria Campaign, Ministry of Health, 555/5 Public Health Complex, Narahenpita, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Hemantha Herath
- Anti Malaria Campaign, Ministry of Health, 555/5 Public Health Complex, Narahenpita, Colombo, Sri Lanka
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Doyno C, Sobieraj DM, Baker WL. Toxicity of chloroquine and hydroxychloroquine following therapeutic use or overdose. Clin Toxicol (Phila) 2020; 59:12-23. [DOI: 10.1080/15563650.2020.1817479] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Cassandra Doyno
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Diana M. Sobieraj
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - William L. Baker
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
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3
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Kumari A, Karnatak M, Singh D, Shankar R, Jat JL, Sharma S, Yadav D, Shrivastava R, Verma VP. Current scenario of artemisinin and its analogues for antimalarial activity. Eur J Med Chem 2018; 163:804-829. [PMID: 30579122 DOI: 10.1016/j.ejmech.2018.12.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022]
Abstract
Human malaria, one of the most striking, reemerging infectious diseases, is caused by several types of Plasmodium parasites. Whilst advances have been made in lowering the numbers of cases and deaths, it is clear that a strategy based solely on disease control year on year, without reducing transmission and ultimately eradicating the parasite, is unsustainable. Natural products have served as a template for the design and development of antimalarial drugs currently in the clinic or in the development phase. Artemisinin combine potent, rapid antimalarial activity with a wide therapeutic index and an absence of clinically important resistance. The alkylating ability of artemisinin and its semi-synthetic analogues toward heme related to their antimalarial efficacy are underlined. Although impressive results have already been achieved in malaria research, more systematization and concentration of efforts are required if real breakthroughs are to be made. This review will concisely cover the clinical, preclinical antimalarial and current updates in artemisinin based antimalarial drugs. Diverse classes of semi-synthetic analogs of artemisinin reported in the last decade have also been extensively studied. The experience gained in this respect is discussed.
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Affiliation(s)
- Akriti Kumari
- Department of Chemistry, Banasthali University, Banasthali Newai, 304022, Rajasthan, India
| | - Manvika Karnatak
- Department of Chemistry, Banasthali University, Banasthali Newai, 304022, Rajasthan, India
| | - Davinder Singh
- Bio-Organic Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu, 180001, Jammu and Kashmir, India
| | - Ravi Shankar
- Bio-Organic Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu, 180001, Jammu and Kashmir, India
| | - Jawahar L Jat
- Department of Applied Chemistry, BabaSaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raebareli Road, Lucknow, 226025, India
| | - Siddharth Sharma
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur, 313001, India
| | - Dinesh Yadav
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur, 313001, India
| | - Rahul Shrivastava
- Department of Chemistry, Manipal University Jaipur, Jaipur, 303007, India
| | - Ved Prakash Verma
- Department of Chemistry, Banasthali University, Banasthali Newai, 304022, Rajasthan, India.
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4
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Varo R, Crowley VM, Sitoe A, Madrid L, Serghides L, Bila R, Mucavele H, Mayor A, Bassat Q, Kain KC. Safety and tolerability of adjunctive rosiglitazone treatment for children with uncomplicated malaria. Malar J 2017; 16:215. [PMID: 28535809 PMCID: PMC5442675 DOI: 10.1186/s12936-017-1858-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/12/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the widespread use and availability of rapidly acting anti-malarials, the fatality rate of severe malaria in sub-Saharan Africa remains high. Adjunctive therapies that target the host response to malaria infection may further decrease mortality over that of anti-malarial agents alone. Peroxisome proliferator-activated receptor-gamma agonists (e.g. rosiglitazone) have been shown to act on several pathways implicated in the pathogenesis of severe malaria and may improve clinical outcome as an adjunctive intervention. METHODS In this study, the safety and tolerability of adjunctive rosiglitazone in paediatric uncomplicated malaria infection was evaluated in Mozambique, as a prelude to its evaluation in a randomized controlled trial in paediatric severe malaria. The study was a prospective, randomized, double-blind, placebo-controlled, phase IIa trial of rosiglitazone (0.045 mg/kg/dose) twice daily for 4 days versus placebo as adjunctive treatment in addition to Mozambican standard of care (artemisinin combination therapy Coartem®) in children with uncomplicated malaria. The primary outcomes were tolerability and safety, including clinical, haematological, biochemical, and electrocardiographic evaluations. RESULTS Thirty children were enrolled: 20 were assigned to rosiglitazone and 10 to placebo. Rosiglitazone treatment did not induce hypoglycaemia nor significantly alter clinical, biochemical, haematological, or electrocardiographic parameters. CONCLUSIONS Adjunctive rosiglitazone was safe and well-tolerated in children with uncomplicated malaria, permitting the extension of its evaluation as adjunctive therapy for severe malaria. The trial is registered with Clinicaltrials.gov, NCT02694874.
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Affiliation(s)
- Rosauro Varo
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 5th Floor, 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique
| | - Valerie M Crowley
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique
| | - Lola Madrid
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 5th Floor, 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique
| | - Lena Serghides
- Toronto General Research Institute (TGRI), University Health Network, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Immunology and Institute of Medical Sciences University of Toronto, Toronto, Canada
| | - Rubao Bila
- Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique
| | - Helio Mucavele
- Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique
| | - Alfredo Mayor
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 5th Floor, 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 5th Floor, 08036, Barcelona, Spain. .,Centro de Investigação em Saúde de Manhiça, Rua 12, Vila da Manhiça, 1929, Maputo, Mozambique. .,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.
| | - Kevin C Kain
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Tropical Diseases Unit, Division of Infectious Diseases, Department of Medicine, UHN-Toronto General Hospital, Toronto, ON, Canada
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5
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Prophylactic efficacy of primaquine for preventing Plasmodium falciparum and Plasmodium vivax parasitaemia in travelers: A meta-analysis and systematic review. Travel Med Infect Dis 2017; 17:5-18. [PMID: 28450185 DOI: 10.1016/j.tmaid.2017.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/21/2017] [Accepted: 04/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. METHODS Using MeSH terms, 756 records were detected through searching "Pubmed", "Embase","Web of Science"and "Cochrane" databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. RESULTS Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16-0.41--RRvivax = 0.16, CI 95%:0.07-0.36--RRfalciparum = 0.31, CI 95%:0.18-0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). CONCLUSIONS For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivax malaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.
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6
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Fernández-Álvaro E, Hong WD, Nixon GL, O’Neill PM, Calderón F. Antimalarial Chemotherapy: Natural Product Inspired Development of Preclinical and Clinical Candidates with Diverse Mechanisms of Action. J Med Chem 2016; 59:5587-603. [DOI: 10.1021/acs.jmedchem.5b01485] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Elena Fernández-Álvaro
- Diseases of the Developing World, Tres
Cantos Medicines Development Campus, GlaxoSmithKline, c/Severo Ochoa, 2, 28760, Tres Cantos, Madrid, Spain
| | - W. David Hong
- Robert Robinson
Laboratories, Department of Chemistry, University of Liverpool, Crown Street, Liverpool L69 7ZD, U.K
| | - Gemma L. Nixon
- Robert Robinson
Laboratories, Department of Chemistry, University of Liverpool, Crown Street, Liverpool L69 7ZD, U.K
| | - Paul M. O’Neill
- Robert Robinson
Laboratories, Department of Chemistry, University of Liverpool, Crown Street, Liverpool L69 7ZD, U.K
| | - Félix Calderón
- Diseases of the Developing World, Tres
Cantos Medicines Development Campus, GlaxoSmithKline, c/Severo Ochoa, 2, 28760, Tres Cantos, Madrid, Spain
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7
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Affiliation(s)
- Frederique A Jacquerioz
- Tropical Medicine, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, Louisiana, USA, LA 70112
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8
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Chaparro M, Vidal J, Angulo-Barturen Í, Bueno JM, Burrows J, Cammack N, Castañeda P, Colmenarejo G, Coterón JM, de las Heras L, Fernández E, Ferrer S, Gabarró R, Gamo FJ, García M, Jiménez-Díaz MB, Lafuente MJ, León ML, Martínez MS, Minick D, Prats S, Puente M, Rueda L, Sandoval E, Santos-Villarejo Á, Witty M, Calderón F. Case Study of Small Molecules As Antimalarials: 2-Amino-1-phenylethanol (APE) Derivatives. ACS Med Chem Lett 2014; 5:657-61. [PMID: 24944739 PMCID: PMC4060931 DOI: 10.1021/ml500015r] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/12/2014] [Indexed: 12/31/2022] Open
Abstract
Antiparasitic oral drugs have been associated to lipophilic molecules due to their intrinsic permeability. However, these kind of molecules are associated to numerous adverse effects, which have been extensively studied. Within the Tres Cantos Antimalarial Set (TCAMS) we have identified two small, soluble and simple hits that even presenting antiplasmodial activities in the range of 0.4-0.5 μM are able to show in vivo activity.
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Affiliation(s)
- María
J. Chaparro
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Jaume Vidal
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Íñigo Angulo-Barturen
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - José M. Bueno
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Jeremy Burrows
- Medicines
for Malaria Venture (MMV), 20 route de
Pré-Bois, 1215 Geneva 15, Switzerland
| | - Nicholas Cammack
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Pablo Castañeda
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Gonzalo Colmenarejo
- Centro
de Investigación Básica, GlaxoSmithKline, Santiago Grisolía, 28760 Tres Cantos, Madrid, Spain
| | - José M. Coterón
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Laura de las Heras
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Esther Fernández
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Santiago Ferrer
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Raquel Gabarró
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Francisco J. Gamo
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Mercedes García
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - María B. Jiménez-Díaz
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - María J. Lafuente
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - María L. León
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - María S. Martínez
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Douglas Minick
- GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, Durham, North Carolina 27709, United States
| | - Sara Prats
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Margarita Puente
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Lourdes Rueda
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Elena Sandoval
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Ángel Santos-Villarejo
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Michael Witty
- Medicines
for Malaria Venture (MMV), 20 route de
Pré-Bois, 1215 Geneva 15, Switzerland
| | - Félix Calderón
- Tres
Cantos, Medicines Development Campus, DDW, GlaxoSmithKline, Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
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9
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Vliegenthart-Jongbloed K, de Mendonça Melo M, van Wolfswinkel ME, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Severity of imported malaria: protective effect of taking malaria chemoprophylaxis. Malar J 2013; 12:265. [PMID: 23902640 PMCID: PMC3734097 DOI: 10.1186/1475-2875-12-265] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Although chemoprophylaxis remains an important strategy for preventing malaria in travellers, its effectiveness may be compromised by lack of adherence. Inappropriate use of chemoprophylaxis is likely to increase the risk of acquiring malaria, but may probably also worsen the severity of imported cases. The aim of this study was to assess the impact of use of malaria chemoprophylaxis on clinical features and outcome of imported malaria. Methods Demographic, clinical and laboratory data of patients included in the Rotterdam Malaria Cohort between 1998 and 2011 were systematically collected and analysed. Patients were classified as self-reported compliant or non-compliant users or as non-users of chemoprophylaxis. Severe malaria was defined using the 2010 WHO criteria. Results Details on chemoprophylaxis were available for 559 of the 604 patients, of which 64.6% were non-users, 17.9% were inadequate users and 17.5% reported to be adequate users. The group of non-users was predominated by patients with African ethnicity, partial immunity and people visiting friends and relatives. The majority contracted Plasmodium falciparum malaria. In contrast, compliant users acquired non-falciparum malaria more frequently, had significant lower P. falciparum loads on admission, shorter duration of hospitalization and significant lower odds for severe malaria as compared with non-users. Patients with P. falciparum malaria were more likely to have taken their chemoprophylaxis less compliantly than those infected with non-P. falciparum species. Multivariate analysis showed that self-reported adequate prophylaxis and being a partially immune traveller visiting friends and relatives was associated with significantly lower odds ratio of severe malaria. In contrast, age, acquisition of malaria in West-Africa and being a non-immune tourist increased their risk significantly. Conclusions Compliant use of malaria chemoprophylaxis was associated with significantly lower odds ratios for severe malaria as compared with non-compliant users and non-users of chemoprophylaxis. After correction for age, gender and immunity, this protective effect of malaria chemoprophylaxis was present only in individuals who adhered compliantly to use of chemoprophylaxis. Patients with P. falciparum malaria were more likely to have used their chemoprophylaxis less compliantly than patients with non-P. falciparum malaria who were more likely to have contracted malaria in spite of compliant use of chemoprophylaxis.
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10
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Holvey C, Connolly A, Taylor D. Psychiatric side effects of non-psychiatric drugs. Br J Hosp Med (Lond) 2010; 71:432-6. [DOI: 10.12968/hmed.2010.71.8.77664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Malaria infects 10,000 to 30,000 international travellers each year. It can be prevented through anti-mosquito measures and drug prophylaxis. However, antimalaria drugs have adverse effects which are sometimes serious. OBJECTIVES To compare the effects of currently used antimalaria drugs when given as prophylaxis to non-immune adult and child travellers who are travelling to regions with Plasmodium falciparum resistance to chloroquine. Specifically, to assess the efficacy, safety, and tolerability of atovaquone-proguanil, doxycycline, and mefloquine compared to each other, and also when compared to chloroquine-proguanil and to primaquine. SEARCH STRATEGY In August 2009 we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, EMBASE, LILACS, BIOSIS, mRCT, and reference lists. We handsearched conference proceedings and one specialist journal, and contacted researchers and drug companies. We searched PubMed for drug-related deaths. SELECTION CRITERIA Randomized and quasi-randomized controlled trials of any antimalaria drug regimen currently used by non-immune international travellers. DATA COLLECTION AND ANALYSIS We independently extracted data and assessed eligibility and risk of bias using a standardized data collection form. We resolved any disagreement through discussion. We combined dichotomous outcomes using risk ratio (RR) and continuous data using mean difference (MD), presenting both with 95% confidence intervals (CI). MAIN RESULTS Eight trials (4240 participants) met the inclusion criteria. Evidence on comparative efficacy from head-to-head comparisons was limited. Atovaquone-proguanil compared to doxycycline had similar adverse events reported. Compared to mefloquine, atovaquone-proguanil users had fewer reports of any adverse effect (RR 0.72, 95% CI 0.6 to 0.85), gastrointestinal adverse effects (RR 0.54, 95% CI 0.42 to 0.7), neuropsychiatric adverse events (RR 0.86, 95% CI 0.75 to 0.99), and neuropsychiatric adverse effects (RR 0.49, 95% CI 0.38 to 0.63), besides a better total mood disturbance score (MD -7.20, 95% CI -10.79 to -3.61). Similarly, doxycycline users had fewer reported neuropsychiatric events than mefloquine users (RR 0.84, 95% CI 0.73 to 0.96). We also examined these three regimens against chloroquine-proguanil; this latter regimen had more reports of any adverse effect (RR 0.84, 95% CI 0.73 to 0.96) and of gastrointestinal adverse effects (RR 0.71, 95% CI 0.6 to 0.85). AUTHORS' CONCLUSIONS Atovaquone-proguanil and doxycycline are the best tolerated regimens, and mefloquine is associated with adverse neuropsychiatric outcomes.
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Affiliation(s)
- Frederique A Jacquerioz
- Center for Evidence-Based Global Health, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, TDW, Ste 1820, New Orleans, Louisiana, USA, 70115
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12
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AlKadi HO. Antimalarial Drug Toxicity: A Review. Chemotherapy 2007; 53:385-91. [DOI: 10.1159/000109767] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 08/07/2006] [Indexed: 01/08/2023]
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13
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Ranque S, Parola P, Adehossi E, Brouqui P, Delmont J. Mefloquine versus 3-day oral quinine–clindamycin in uncomplicated imported falciparum malaria. Travel Med Infect Dis 2007; 5:306-9. [PMID: 17870636 DOI: 10.1016/j.tmaid.2007.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 06/27/2007] [Accepted: 07/04/2007] [Indexed: 10/22/2022]
Abstract
In this open randomized trial comparing 3-day oral quinine-clindamycin versus standard mefloquine regimen for uncomplicated imported falciparum malaria, mefloquine treatment was associated with a higher risk of discontinuation of the treatment (RR=1.8, 95% CI [1.1-2.8]) related to mainly mild gastrointestinal adverse drug events. The poor tolerability of mefloquine sets a question mark against its use in outpatients.
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Affiliation(s)
- Stéphane Ranque
- Laboratoire de Parasitologie et Mycologie, IFR 48, Faculté de Médecine, 27 Bd. Jean Moulin, 13385 Marseille Cedex 5, France.
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14
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Affiliation(s)
- Ashley M Croft
- Medical Branch, Headquarters 5th Division, Copthorne Barracks, Shrewsbury SY3 8LZ, UK.
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Affiliation(s)
- Ashley M Croft
- Medical Branch, Headquarters 5th Division, Copthorne Barracks, Shrewsbury SY3 8LZ, UK.
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Gkrania-Klotsas E, Lever AML. An update on malaria prevention, diagnosis and treatment for the returning traveller. Blood Rev 2007; 21:73-87. [PMID: 16815604 DOI: 10.1016/j.blre.2006.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The diagnosis of malaria needs to be considered for every returning traveller with a fever. Compliance with prevention, both pharmaceutical and non-pharmaceutical, is essential for every traveller. New tests for diagnosis are now available. Treatment options have recently expanded to include the artemisinin derivatives that used to be unavailable in the western countries.
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Croft AM, Jackson CJ, Darbyshire AH. Doxycycline for the prevention of tick-borne relapsing fever. N Engl J Med 2006; 355:1614; author reply 1614-5. [PMID: 17035657 DOI: 10.1056/nejmc062175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Most available antimalarial drugs induce cardiac side effects. These side effects include various mild heart rate changes (amodiaquine) to excessive prolongation of the QT interval (halofantrine) which may lead to lethal arrhythmias such as Torsade de Pointes (TdP). The cellular mechanism of such events during antimalarial therapy is principally related to ion channel inhibition (e.g., human ether-a-go-go related gene channel) which may slow the repolarisation process and create a good substrate for arrhythmia (when dispersion of repolarisation is present). However, other antimalarial drugs do not show as potent cardiac side effects, like co-arthemeter and sulfadoxine-pyrimethamine. Considering that TdP are favoured by a complex combination of electrophysiological changes, a predictive cardiosafety strategy for new antimalarial drugs should comprise assays with an increasing level of information from ion channel level, cellular and organ level, to the whole organism. In this review, the actual knowledge on underlying mechanisms of QT prolongation and TdP is described, followed by the cardiac safety profiles of present antimalarial drugs.
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Affiliation(s)
- Martin Traebert
- Exploratory Development, Safety Profiling and Assessment, Novartis Pharma AG, MUT-2881.204, CH-4002 Basel, Switzerland.
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