Confusion over the recommended doses of proguanil and chloroquine for children has been highlighted by a reader of The Journal following the publication of a continuing education article on malaria (PJ, March 11, p405).
For both drugs, the dose for children aged two listed in the British National Formulary (BNF) and Communicable Diseases Review (CDR) guide is half of the adult dose. However, the summaries of product characteristics give the dose as a quarter of the adult dose.
The Malaria Reference Laboratory told The Journal on March 28 that it would recommend the higher dose and added that the problem had been ongoing for many years. Dr Larry Goodyer (superintendent of Nomad Travel Pharmacy and author of the continuing education travel medicine series) commented that, while he would normally recommend the dose in the CDR and BNF, pharmacists had to consider the legal implications as these doses were not licensed. He also questioned the efficacy of the lower dose, saying that there was some doubt that the current dose of chloroquine was high enough even in adults and that, as children were at a greater risk of malaria than adults, the BNF/CDR dose might be more appropriate. However, the confusion is set to be resolved soon by the publication of guidelines by the Public Health Laboratory Service Advisory Committe on malaria prevention for UK travellers. Dr Barbara Bannister (chairwoman of the commitee) told The Journal on March 29 that the aim of the guidelines was to make the drug regimes easier to understand. Extensive work and consultation had been going on for the past year and she hoped that they would be available by Easter.
Ms Fiona Tigar (head of public relations and communications, Astra Zeneca) told The Journal on March 29 that the company believed that the dose in the SPC was effective but that if the forthcoming guidelines recommended the higher dose then it would seek advice from experts. It would contact the Medicines Control Agency about changing the data sheet if recommended to do so.