In 2016, Eli Schwartz and his team in Israel published an observational study among 122 long term travellers to West Africa: 63 refused prophylaxis, 40 took mefloquine, and 33 took malarone (AP) twice-weekly.

Results:

• No prophylaxis: 16 cases per 1368 person-months at risk
• Mefloquine: 2 cases per 983 person-months at risk
• AP twice-weekly: 0 cases per 391 person-months at risk

This nice study builds on existing evidence to support less frequent dosing of AP (2) – and to discontinue AP on the day of return from a malaria-endemic area rather than seven days (3).

Although some practitioners have begun to reduce the dosing frequency and duration of AP prescribed, others are calling for more studies – and the US CDC and Canadian  CATMAT recommendations remain unchanged.

Although rare, there have been prophylaxis failures in patients taking AP daily. Resistance to atovaquone (A) may be related to single point mutation in parasite cytochrome b; resistance to proguanil may require several stepwise point mutations in the dhfr gene regulating folate metabolism.

What do others think?

If you were travelling to West Africa, would you take AP daily or twice weekly?  Would you continue for a week after return?

Please comment below….