title: Efficacy and safety of atovaquone-proguanil in treating imported malaria in Japan: the second report from the research group.
abstract: Malaria remains an important health risk among travelers to tropical/subtropical regions. However, in Japan, only 2 antimalarials are licensed for clinical use - oral quinine and mefloquine. The Research Group on Chemotherapy of Tropical Diseases introduced atovaquone-proguanil in 1999, and reported on its excellent antimalarial efficacy and safety for treating non-immune patients with uncomplicated Plasmodium falciparum malaria (20 adult and 3 pediatric cases) in 2006. In the present study, additional cases of malaria were analyzed to confirm the efficacy and safety of this antimalarial drug. Fourteen adult and 2 pediatric cases of P. falciparum malaria and 13 adult cases and 1 pediatric case of P. vivax/ovale malaria were successfully treated with atovaquone-proguanil, including 3 P. falciparum cases in which the antecedent treatment failed. Two patients with P. vivax malaria were treated twice due to primaquine treatment failure as opposed to atovaquone-proguanil treatment failure. Except for 1 patient with P. falciparum malaria who developed a moderate liver function disturbance, no significant adverse effects were observed. Despite the intrinsic limitations of this study, which was not a formal clinical trial, the data showed that atovaquone-proguanil was an effective and well-tolerated therapeutic option; licensure of this drug in Japan could greatly contribute to individually appropriate treatment options.
authors.affiliation: Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan. kimumiki@abox3.so-net.ne.jp
authors.forename: Mikio
authors.initials: M
authors.lastname: Kimura
authors.forename: Michiko
authors.initials: M
authors.lastname: Koga
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Miura
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Maruyama
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D053626:Atovaquone / Q000494:pharmacology / Q000627:therapeutic use*; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000208:ethnology; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D002727:Proguanil / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D002727:Proguanil; D053626:Atovaquone