[Tolerance and efficacy of atovaquone-proguanil for the treatment of paediatric imported Plasmodium falciparum malaria in France: clinical practice in a university hospital in Paris].
Only few drugs for uncomplicated Plasmodium falciparum malaria are available in children. Atovaquone-proguanil is a recent antimalarial drug licensed in France for the uncomplicated P. falciparum malaria in adults. Few paediatric studies have evaluated atovaquone-proguanil in children for uncomplicated malaria in endemic area, but no study have evaluated this treatment for imported malaria.


OBJECTIVE
To evaluate treatment by atovaquone-proguanil for uncomplicated and imported P. falciparum malaria in children.


METHODS
We retrospectively evaluated the tolerance and the efficacy of atovaquone-proguanil in the children admitted in Robert-Debré Hospital (Paris) for a P. falciparum malaria. From January 2004 to December 2005, 48 children with a median age of 7,5 years (IQR 4-11) were treated with atovaquone-proguanil for a uncomplicated P. falciparum malaria, except for 5 children who had an isolated hyperparasitemia greater or equal to 5%.


RESULTS
Atovaquone-proguanil was stopped for 3/48 children because of vomiting. Fever resolved in all the children between Day 3 and 7, following the beginning of the treatment. One child, with a favourable outcome, had a positive parasitemia at Day 4 equal to the initial parasitemia (0,1%). No late therapeutic failure was observed among the 24 children evaluated up to one month after starting treatment.


CONCLUSIONS
Atovaquone-proguanil is an efficient and well-tolerated antimalarial treatment for uncomplicated P. falciparum malaria in children. The risk of vomiting should lead to a systematic initial hospitalisation of children treated with atovaquone-proguanil.
Blondé
R
R
Service de pédiatrie générale, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France.
Naudin
J
J
Bigirimana
Z
Z
Holvoet
L
L
Fenneteau
O
O
Vitoux
C
C
Bourdon
O
O
Angoulvant
F
F
Lorrot
M
M
D'Ortenzio
E
E
Bourrillon
A
A
Le Bras
J
J
Matheron
S
S
Faye
A
A
D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D006785:Hospitals, University; D006801:Humans; D008111:Liver Function Tests; D016778:Malaria, Falciparum / Q000188:drug therapy*; D010297:Paris; D010963:Plasmodium falciparum; D002727:Proguanil / Q000627:therapeutic use*; D012189:Retrospective Studies; D014195:Travel
D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D002097:C-Reactive Protein; D002727:Proguanil; D053626:Atovaquone