title: Malaria chemoprophylaxis: what do the travelers choose, and how does pretravel consultation influence their final decision.
abstract: Three different drugs (mefloquine, atovaquone/proguanil, doxycycline) are recommended for malaria chemoprophylaxis, each with approximately the same efficacy but various adverse event profiles, regimens, and prices. We investigated which medication the travelers would have chosen on the basis of written evidence-based information and the impact that pretravel consultation had on their decision. A prospective study was performed in a travel clinic and private practice, and 1073 travelers were included; 45% chose mefloquine (Lariam or Mephaquine), 21% atovaquone/proguanil (Malarone), 18% doxycycline (Supracycline), 5% "no prophylaxis," and 11% "do not know." Lariam was principally chosen because of prior experience (38%), Mephaquine because of low price (34%), and doxycycline and Malarone because of the profile of adverse events (55% and 43%, respectively). Based on objective written information, travelers most frequently chose mefloquine for chemoprophylaxis. This suggests that evidence-based information weighs more heavily than negative publicity. Taking into account the perspective of the user should improve appropriateness of the pretravel advice.
authors.affiliation: Travel Clinic, Department of Ambulatory Care and Community Medicine, Switzerland. nicolas.senn@gmail.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Senn
authors.forename: Valérie
authors.initials: V
authors.lastname: D'Acremont
authors.forename: Pierre
authors.initials: P
authors.lastname: Landry
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D053626:Atovaquone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D054626:Consumer Health Information; D003657:Decision Making; D004318:Doxycycline / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D015767:Mefloquine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D002727:Proguanil / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D013557:Switzerland; D013997:Time Factors; D014195:Travel
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D004318:Doxycycline; D002727:Proguanil; D015767:Mefloquine; D053626:Atovaquone