Disparities exist in the availability of outpatient malaria treatment in Maryland, USA.
BACKGROUND
Prior review of pediatric malaria cases in the Washington, DC area raised concern that there may be systematic barriers to the timely procurement of antimalarial medications for those patients being treated for malaria as outpatients. We hypothesized that the local availability of antimalarial medications was not consistent across communities of differing socioeconomic status.


METHODS
We administered a blinded telephone questionnaire to pharmacists in the Maryland suburbs of Washington, DC and assessed the in-stock availability of antimalarial medication. Pharmacies were stratified into categories of population risk, disease incidence, and income.


RESULTS
Pharmacies in high-income ZIP codes were more likely to stock first-line therapy medications (93%, p = 0.03) than pharmacies in moderate-income, low-incidence, low-risk ZIP codes (50%). Moderate-income ZIP codes with high-malaria incidence and a high-risk population (67%, p = 0.35) were no more likely to stock first-line antimalarial medications than pharmacies in moderate-income, low-incidence, low-risk areas (50%). In all, only four (9%) pharmacies stocked quinine. Many pharmacists stated the reason for this discrepancy was that they believed the Food and Drug Administration (FDA) had "pulled quinine off the market."


CONCLUSIONS
In the United States, disparities exist in the availability of outpatient-antimalarial medications. We recommend that a complete outpatient treatment course is dispensed, or the availability of the medication at the pharmacy that the patient will use is verified prior to departure from the clinic or emergency department. Pharmacists and physicians should be aware that the FDA restrictions on the use of quinine sulfate do not apply to its use for the treatment of malaria.
Bear
Kelly A
KA
Department of Pediatrics, Uniformed Services University, Bethesda, MD 20866, USA.
Higginson
Amanda I
AI
Hickey
Patrick W
PW
D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003157:Community Pharmacy Services / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008396:Maryland; D010594:Pharmacies / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D000962:Antimalarials