title: Safety, Tolerability, and Compliance with Long-Term Antimalarial Chemoprophylaxis in American Soldiers in Afghanistan.
abstract: Long-term antimalarial chemoprophylaxis is currently used by deployed U.S. military personnel. Previous small, short-term efficacy studies have shown variable rates of side effects among patients taking various forms of chemoprophylaxis, though reliable safety and tolerability data on long-term use are limited. We conducted a survey of troops returning to Fort Drum, NY following a 12-month deployment to Operation Enduring Freedom, Afghanistan from 2006 to 2007. Of the 2,351 respondents, 95% reported taking at least one form of prophylaxis during their deployment, and 90% were deployed for > 10 months. Compliance with daily doxycycline was poor (60%) compared with 80% with weekly mefloquine (MQ). Adverse events (AEs) were reported by approximately 30% with both MQ and doxycycline, with 10% discontinuing doxycycline compared with 4% of MQ users. Only 6% and 31% of soldiers reported use of bed nets and skin repellents, respectively. Compliance with long-term malaria prophylaxis was poor, and there were substantial tolerability issues based on these anonymous survey results, though fewer with MQ than doxycycline. Given few long-term antimalarial chemoprophylaxis options, there is an unmet medical need for new antimalarials safe for long-term use.
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington david.saunders@afrims.org.
authors.forename: David L
authors.initials: DL
authors.lastname: Saunders
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Garges
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Manning
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Kent
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schaffer
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kosmowski
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Magill
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000453:epidemiology; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D015767:Mefloquine / Q000009:adverse effects / Q000627:therapeutic use; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000208:ethnology; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D004318:Doxycycline; D015767:Mefloquine