New malaria prophylaxis guidelines welcomed
The publication of new guidelines concerning malaria
prophylaxis (PJ, 21 July, p92) has been welcomed by Dr Larry Goodyer,
head of pharmacy practice at King’s College, London, and superintendent
of Nomad Travel Pharmacy.
Dr Goodyer told The Journal that the new
guidelines clarify what was becoming a somewhat confusing picture with
regard to recommending malaria chemoprophylaxis. He added: “Although [the
guidelines] are in broad agreement with the current British National Formulary,
pharmacists should note that some discrepancies do exist between the two.”
For instance, Malarone is licensed for up to 28 days’ use, whereas the
BNF recommends that it can be used for up to three months.
This discrepancy is because Malarone received its
licence for use in malaria prophylaxis after the current edition of the
BNF was pulished.
Dr Goodyer also pointed out that the BNF makes some
recommendations on the maximum periods for taking doxycycline (three months)
and chloroquine/proguanil (five years), as well as the possibility of
starting these regimens less than a week before travel in some circumstances.
These points are not referred to in the guidelines. “Hopefully future
editions of the BNF will clear this up,” he said.
Dr Goodyer was disappointed that travellers are
still recommended to impregnate clothing with DEET by dipping the clothes
in a dilution of DEET. “This is a very messy procedure, will only last
a maximum of five days, and, in my experience, is rarely undertaken by
travellers.” Dr Goodyer recommends that clothing should be treated with
permethrin, in addition to using a repellent on the exposed skin.
He would also like to see further clarification
on Table 7 and Table 8 of the new guidelines, as they do not always give
alternative regimens. In response to Dr Goodyer’s request for clarification,
Professor Bradley, one of the authors of the new guidelines said that
travellers who could not take the recommended regimen, and for whom there
was no alternative regimen given, should consult a physician or specialist
travel clinic.
With regard to upper time limits being set for taking
malaria prophylaxis, he added: “There is considerable difficulty in setting
an upper time limit for prophylactic antimalarials in practice as good
data are scarce. The guidelines were therefore cautious over this.”
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