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Clin Infect Dis. 2018 May 17;66(11):1751-1755. doi: 10.1093/cid/cix1077.

Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options.

Author information

1
Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel.
2
Department of Medicine C, Tel Hashomer, Israel.
3
Infectious Diseases Unit, The Sheba Medical Center, Tel Hashomer, Israel.
4
Sackler School of Medicine, Tel Aviv University, Israel.

Abstract

Background:

Atovaquone-proguanil is considered causal prophylaxis (inhibition of liver-stage schizonts) for Plasmodium falciparum; however, its causal prophylactic efficacy for Plasmodium vivax is not known. Travelers returning to nonendemic areas provide a unique opportunity to study P. vivax prophylaxis.

Methods:

In a retrospective observational study, for 11 years, Israeli rafters who had traveled to the Omo River in Ethiopia, a highly malaria-endemic area, were followed for at least 1 year after their return. Malaria prophylaxis used during this period included mefloquine, doxycycline, primaquine, and atovaquone-proguanil. Prophylaxis failure was divided into early (within a month of exposure) and late malaria.

Results:

Two hundred fifty-two travelers were included in the study. Sixty-two (24.6%) travelers developed malaria, 56 (91.9%) caused by P. vivax, with 54 (87.1%) cases considered as late malaria. Among travelers using atovaquone-proguanil, there were no cases of early P. falciparum or P. vivax malaria. However, 50.0% of atovaquone-proguanil users developed late vivax malaria, as did 46.5% and 43.5% of mefloquine and doxycycline users, respectively; only 2 (1.4%) primaquine users developed late malaria (P < .0001).

Conclusions:

Short-course atovaquone-proguanil appears to provide causal (liver schizont stage) prophylaxis for P. vivax, but is ineffective against late, hypnozoite reactivation-related attacks. These findings suggest that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax.

PMID:
29228132
DOI:
10.1093/cid/cix1077
[Indexed for MEDLINE]

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