Treatment of imported malaria in adults: a multicentre study in France.
BACKGROUND
Data about anti-malarial drugs prescription practices in Europe and the safety of imported malaria treatments are scanty. In 1999, a French consensus development conference published guidelines for the prevention and treatment of imported P. falciparum malaria. The impact of these guidelines has not been evaluated.


OBJECTIVE
To investigate the impact of these guidelines on the prescription of anti-malarials, and to evaluate the incidence of acute drug events (ADEs) leading to discontinuation of treatment.


METHODS
Cross-sectional survey.


METHODS
Members of the medical staff in 14 French infectious and tropical disease wards completed a standardized form for each patient treated for imported malaria in 2001. A propensity score matching technique was used to estimate the risk of ADEs leading to discontinuation of the regimen.


RESULTS
In the 474 patients studied, quinine was the first-line anti-malarial most often prescribed. Only 3% of patients received halofantrine. Mefloquine was associated with a RR of 4.9 (95%CI 3.2-7.4, p < 0.00001) risk of discontinuation of treatment due to ADEs.


CONCLUSIONS
The very limited use of halofantrine indicates that the main practice recommendations of the guidelines have been taken into account. Mefloquine was associated with a substantial risk of discontinuing the treatment because of ADEs. This is a serious limitation for the use of mefloquine in the treatment of out-patients with imported malaria.
Ranque
S
S
Service des Maladies infectieuses et tropicales, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France. stephane.ranque@medecine.univ-mrs.fr
Marchou
B
B
Malvy
D
D
Adehossi
E
E
Laganier
R
R
Tissot-Dupont
H
H
Lotte
A
A
Dydymsky
S
S
Durant
J
J
Stahl
J-P
JP
Bosseray
A
A
Gaillat
J
J
Sotto
A
A
Cazorla
C
C
Ragneau
J-M
JM
Brouqui
P
P
Delmont
J
J
D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome
D000962:Antimalarials