On the potential for discontinuing atovaquone-proguanil (AP) ad-hoc post-exposure and other abbreviated AP-regimens: Pharmacology, pharmacokinetics and perspectives

Autor: Jenny L. Schnyder, Hanna K. de Jong, Emmanuel B. Bache, Reinier M. van Hest, Patricia Schlagenhauf, Steffen Borrmann, Thomas Hanscheid, Martin P. Grobusch
Přispěvatelé: Graduate School, Infectious diseases, Pharmacy, AII - Infectious diseases, APH - Global Health, University of Zurich, Grobusch, Martin P
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Travel medicine and infectious disease, 52:102520. Elsevier USA
ISSN: 1477-8939
Popis: According to current guidelines, atovaquone-proguanil (AP) malaria chemoprophylaxis should be taken once daily starting one day before travel and continued for seven days post-exposure. However, drug-sparing regimens, including discontinuing AP after leaving malaria-endemic areas are cost-saving and probably more attractive to travelers, and may thus enhance adherence. AP has causal prophylactic effects, killing malaria parasites during the hepatic stage. If early hepatic stages were already targeted by AP, AP could possibly be discontinued upon return. Pharmacokinetic data and studies on drug-sparing AP regimens suggest this to be the case. Nevertheless, the evidence is weak and considered insufficient to modify current recommendations. Field trials require large numbers of travelers and inherently suffer from the lack of a control group. Safely-designed controlled human malaria infection trials could significantly reduce study participant numbers and safely establish an effective AP abbreviated regimen which we propose as the optimal trial design to test this concept.
Databáze: OpenAIRE
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