More Non-compliance with Antimalarials
Source: Behrens RH, et al. J Travel Med 1998;5:92-94.
Behrens and colleagues at the London Hospital for Tropical Diseases assessed adherence to malaria prophylaxis in travelers returning from chloroquine-resistant Plasmodium falciparum-endemic countries diagnosed with P. falciparum or P. vivax. Self-reported compliance was compared with serum levels of various antimalarial agents as determined by HPLC.
Use of chemoprophylaxis in patients with malaria was poor. Non-immune patients (n = 259) used some prophylaxis 75% of the time; immune patients (n = 109), who had previously resided in a malaria-endemic country for two or more years, used prophylaxis only 28% of the time. Twenty-six percent of those with P. falciparum infection self-treated for malaria before presentation. Assessment of serum concentrations suggested that 50% of the remaining patients tested had blood levels that were inconsistent with their reported use, including 25% with serum levels that were higher than that expected and 25% with inadequate serum levels lower than that expected. Only 13% of patients were fully compliant and properly using a recommended regimen.
Remarkably similar observations were made in a group of 100 travelers diagnosed with malaria in Toronto, most of whom had sought pre-travel advice from a physician, but only 11% had used antimalarial prophylaxis and 17% inset precautions (Kain KC, et al. Clin Infect Dis 1998;27:142-149).
These data show that many travelers-at least those who develop malaria-don't take their antimalarial prophylaxis correctly, let alone remember when they took their last dose. Patient history should not be relied upon in the evaluation of the febrile patient at risk for malaria. Research is clearly needed with regard to methods of improving compliance with antimalarials.
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