The Pharmaceutical Journal
Vol 268 No 7189 p349-354
16 March 2002

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Pharmacists give good advice on OTC antimalarials but confusion exists over options on prescription

Pharmacists give appropriate advice about over-the-counter malaria prophylaxis but confusion exists over prescription-only regimens, research shows.

Dr Larry Goodyer, head of pharmacy practice, King's College London, presented the findings of a study examining advice given by community pharmacists on malaria prophylaxis at the British Travel Health Association's annual meeting in London last week. Kathryn McNamara, final year student, school of pharmacy, King's College London, and Dr Goodyer assessed the advice given at 30 pharmacies (half multiples and half independents) through two simulated consultations. In one scenario, a female backpacker asked advice for a three-month visit to sub-Saharan Africa. The other involved a child's visit to India.

For the child, 29 pharmacists correctly recommended chloroquine and proguanil and one recommended mefloquine. Only one-third asked about the child's weight. Nearly all recommended that treatment should be started one week before the trip and continued for four weeks afterwards.

For the backpacker, 20 per cent correctly stated that mefloquine or doxycycline would be potential first-line choices. A further 70 per cent identified mefloquine as a first-line choice, but not doxycycline as an equal alternative. A total of eight different recommendations were made. Of the 27 pharmacists who recommended use of mefloquine, only one said that correctly it should be taken for two and a half weeks before travel.

The researchers concluded that many pharmacists are not aware of the equivalence of choices available for sub-Saharan Africa. Dr Goodyer suggests that the layout of regimens in the British National Formulary could be causing confusion. It reads: "... preferably mefloquine or doxycycline or atovaquone/proguanil or, if the above are not appropriate, chloroquine plus proguanil."

Tarina Shing, staff editor, BNF, agreed that the BNF advice could be misconstrued. She said that the BNF reflects the advice of UK malaria experts that, for sub-Saharan Africa, any one of the first three choices is preferable to prophylaxis with chloroquine and proguanil. She added: "The March edition of the BNF is in press but in view of Dr Goodyer's concerns we will certainly review the presentation of the advice for the September 2002 issue of the BNF."

However, the researchers did find that pharmacists gave appropriate advice about chloroquine and proguanil. They suggest that if pharmacists were able to prescribe all malaria prophylactics, advice on other drugs would improve.