title: Malaria chemoprophylaxis regimens: a descriptive drug utilization study.
abstract: BACKGROUND
  Mefloquine belongs to the priority chemoprophylaxis drugs for travelers to malaria endemic regions. We aimed to assess the prescribing patterns for mefloquine and other antimalarials.
  
  
  METHODS
  We conducted a descriptive drug utilization study using the U.K. Clinical Practice Research Datalink (CPRD). We assessed characteristics of individuals with a first-time antimalarial prescription for mefloquine, atovaquone/proguanil, chloroquine and/or proguanil, or doxycycline between 2001 and 2012.
  
  
  RESULTS
  Of 165,218 individuals with a first-time antimalarial prescription, 108,344 (65.6%), 25,294 (15.3%), 23,195 (14.0%), and 8385 (5.1%) were prescribed atovaquone/proguanil, mefloquine, doxycycline, and chloroquine and/or proguanil, respectively. Among mefloquine users, 7.5% had a history of a neuropsychiatric disorder (versus 12.6%-13.7% among other antimalarial users) and 0.04% had a history of severe liver disease (versus 0.04%-0.1% among other antimalarial users). A total of 19.4% mefloquine users were children younger than 12 years (versus 0.4%-15.8% among other antimalarials), and 1.3% pregnant or postpartum women (versus 0.4%-1.4% among users of other antimalarials).
  
  
  CONCLUSIONS
  The most frequently prescribed antimalarial chemoprophylaxis was atovaquone/proguanil. Mefloquine was occasionally prescribed for patients with comorbidities listed as contraindications, but most practitioners observed contraindications. Mefloquine was often prescribed for children and pregnant women.
authors.affiliation: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University Basel, Switzerland. Electronic address: Marlene.Bloechliger@usb.ch.
authors.forename: Marlene
authors.initials: M
authors.lastname: Bloechliger
authors.affiliation: University of Zurich Centre for Travel Medicine, Institute for Social and Preventive Medicine, Zurich, Switzerland. Electronic address: pat@ifspm.uzh.ch.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
authors.affiliation: Division of Infection and Immunity, Royal Free and University College Medical School, Academic Centre for Travel Medicine and Vaccines, London, UK. Electronic address: malaria@sunrise.ch.
authors.forename: Stephen
authors.initials: S
authors.lastname: Toovey
authors.affiliation: F.Hoffmann-La Roche Ltd., Basel, Switzerland. Electronic address: gabriel.schnetzler@roche.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Schnetzler
authors.affiliation: F.Hoffmann-La Roche Ltd., Basel, Switzerland. Electronic address: iain.tatt@roche.com.
authors.forename: Iain
authors.initials: I
authors.lastname: Tatt
authors.affiliation: F.Hoffmann-La Roche Ltd., Basel, Switzerland. Electronic address: danitza.tomianovic@roche.com.
authors.forename: Danitza
authors.initials: D
authors.lastname: Tomianovic
authors.affiliation: Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, United States. Electronic address: sjick@bu.edu.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
authors.affiliation: Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University Basel, Switzerland; Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, United States; Hospital Pharmacy, University Hospital Basel, Switzerland. Electronic address: Christoph.Meier@usb.ch.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Meier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use; D053626:Atovaquone; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000453:epidemiology; D008288:Malaria / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis; D011247:Pregnancy; D037841:Pregnant People; D002727:Proguanil / Q000627:therapeutic use; D012189:Retrospective Studies; D014195:Travel; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D002738:Chloroquine; D004318:Doxycycline; D002727:Proguanil; D015767:Mefloquine; D053626:Atovaquone
keywords: Atovaquone; Chloroquine; Doxycycline; Mefloquine; Proguanil