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QJM Advance Access published online on August 26, 2005
QJM, 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
Received September 29, 2004
Revised May 31, 2005

Original paper

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

S. Ranque 1*, B. Marchou 2, D. Malvy 2, E. Adehossi 1, R. Laganier 2, H. Tissot-Dupont 2, A. Lotte 2, S. Dydymsky 2, J. Durant 2, J.-P. Stahl 2, A. Bosseray 2, J. Gaillat 2, A. Sotto 2, C. Cazorla 2, J.-M. Ragneau 2, P. Brouqui 1, J. Delmont 1, and for the Infectio-Sud Group

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

* To whom correspondence should be addressed.
S. Ranque, E-mail: stephane.ranque{at}medecine.univ-mrs.fr


  Abstract

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.

Representative members of infectious and tropical diseases services from the InfectioSud Group have participated in this study: Annecy (J.-P. Bru, J. Gaillat); Bordeaux (M. Dupon, H. Dutronc, D. Neau, J.-Y. Lacut, M. Lebras, D. Malvy, J.-M. Ragneau, M. Receveur); Clermont-Ferrand (J. Beytout, S. Dydymsky, F. Gourdon, H. Laurichesse); Grenoble (A. Bosseray, J.-P. Brion, M.-R. Mallaret, P. Pavese, J.-P. Stahl); Lyon (F. Biron, A. Boibieux, C. Chidiac, B. Issartel, R. Laganier, D. Peyramond); Marseille (S. Badiaga, P. Brouqui, J. Delmont, C. Foucault, P. Parola, I. Ravaux, A. Stein, H. Tissot-Dupont); Montpellier (N. Atoui, J. Fabre, M. Siffert, A. Lotte, J. Reynes); Nice (P. Clevenbergh, P. Dellamonica, F. De Salvator, J. Durant, C. Pradier, P.-M. Roger); Nîmes (J. Jourdan, C. Barbuat, A. Sotto); Saint-Etienne (P. Berthelot, C. Cazorla, A. Fresard, F. Lucht); Toulouse (E. Bonnet, L. Cuzin, B. Marchou, P. Massip).
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