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QJM Advance Access originally published online on August 26, 2005
QJM 2005 98(10):737-743; doi:10.1093/qjmed/hci110
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Treatment of imported malaria in adults: a multicentre study in France

S. Ranque, B. Marchou1, D. Malvy1, E. Adehossi, R. Laganier1, H. Tissot-Dupont1, A. Lotte1, S. Dydymsky1, J. Durant1, J.-P. Stahl1, A. Bosseray1, J. Gaillat1, A. Sotto1, C. Cazorla1, J.-M. Ragneau1, P. Brouqui, J. Delmont and for the Infectio-Sud Group*

From the Service des Maladies infectieuses et tropicales, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, and 1INFECTIO-SUD Formation et Recherche, Nice, France

Address correspondence to Dr S. Ranque, INSERM U. 399—Laboratoire de Parasitologie-Mycologie, Faculté de Médecine, 27 Boulevard Jean Moulin, F-13385 Marseille Cedex 5, France. email: stephane.ranque{at}medecine.univ-mrs.fr

Received 29 September 2004 and in revised form 31 May 2005

Background: Data about anti-malarial drugs prescription practices in Europe and the safety of imported malaria treatments are scanty. In 1999, a French consensus development conference published guidelines for the prevention and treatment of imported P. falciparum malaria. The impact of these guidelines has not been evaluated.

Aim: To investigate the impact of these guidelines on the prescription of anti-malarials, and to evaluate the incidence of acute drug events (ADEs) leading to discontinuation of treatment.

Design: Cross-sectional survey.

Methods: Members of the medical staff in 14 French infectious and tropical disease wards completed a standardized form for each patient treated for imported malaria in 2001. A propensity score matching technique was used to estimate the risk of ADEs leading to discontinuation of the regimen.

Results: In the 474 patients studied, quinine was the first-line anti-malarial most often prescribed. Only 3% of patients received halofantrine. Mefloquine was associated with a RR of 4.9 (95%CI 3.2–7.4, p<0.00001) risk of discontinuation of treatment due to ADEs.

Discussion: The very limited use of halofantrine indicates that the main practice recommendations of the guidelines have been taken into account. Mefloquine was associated with a substantial risk of discontinuing the treatment because of ADEs. This is a serious limitation for the use of mefloquine in the treatment of out-patients with imported malaria.

*See Acknowledgements for list.


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