title: Atovaquone-proguanil in the treatment of imported uncomplicated Plasmodium falciparum malaria: a prospective observational study of 553 cases.
abstract: BACKGROUND
  Each year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP's efficacy and tolerance were evaluated in several trials, its use in "real life" conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas.
  
  
  METHODS
  Between September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up.
  
  
  RESULTS
  A total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8% were infected in West Africa, whereas 0.5% were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9% of the patients, the remainder (32.1%) were backpackers. Three-hundred and sixty-four patients (66%) fulfilled follow-up at day 7 and 265 (48%) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77%) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95% [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR.
  
  
  CONCLUSIONS
  This study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.
authors.forename: Hugues
authors.initials: H
authors.lastname: Cordel
authors.forename: Johann
authors.initials: J
authors.lastname: Cailhol
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
authors.forename: Martine
authors.initials: M
authors.lastname: Bloch
authors.forename: Nadine
authors.initials: N
authors.lastname: Godineau
authors.forename: Paul-Henri
authors.initials: PH
authors.lastname: Consigny
authors.forename: Hélène
authors.initials: H
authors.lastname: Gros
authors.forename: Pauline
authors.initials: P
authors.lastname: Campa
authors.forename: Patrice
authors.initials: P
authors.lastname: Bourée
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
authors.forename: Pascal
authors.initials: P
authors.lastname: Ralaimazava
authors.affiliation: Department of Infectious and Tropical Diseases, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France. olivier.bouchaud@avc.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchaud
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use*; D001208:Asia; D053626:Atovaquone / Q000627:therapeutic use*; D002648:Child; D004338:Drug Combinations; D005260:Female; D005602:France; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D002727:Proguanil / Q000627:therapeutic use*; D014171:Transients and Migrants; D014195:Travel; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D002727:Proguanil; D053626:Atovaquone