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Malaria Chemoprophylaxis: What Do the Travelers Choose, and How Does Pretravel Consultation Influence Their Final Decision

Three different drugs (mefloquine, atovaquone/proguanil, doxycycline) are recommended for malaria chemoprophylaxis, each with approximately the same efficacy but various adverse event profiles, regimens, and prices. We investigated which medication the travelers would have chosen on the basis of written evidence-based information and the impact that pretravel consultation had on their decision. A prospective study was performed in a travel clinic and private practice, and 1073 travelers were included; 45% chose mefloquine (Lariam or Mephaquine), 21% atovaquone/proguanil (Malarone), 18% doxycycline (Supracycline), 5% "no prophylaxis," and 11% "do not know." Lariam was principally chosen because of prior experience (38%), Mephaquine because of low price (34%), and doxycycline and Malarone because of the profile of adverse events (55% and 43%, respectively). Based on objective written information, travelers most frequently chose mefloquine for chemoprophylaxis. This suggests that evidence-based information weighs more heavily than negative publicity. Taking into account the perspective of the user should improve appropriateness of the pretravel advice.

Received March 6, 2007. Accepted for publication August 4, 2007.

Financial support: Core funding was provided by the Travel Clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne.

Disclaimer: All authors certify that no funding was provided by pharmaceutical companies. None of the authors has served as consultant or received honoraria from any of the pharmaceutical companies manufacturing the drugs. B.G. received travel grants from GSK, unrelated to the present study. All authors certify having no conflicts of interest.

^* Address correspondence to Nicolas Senn, PNG Institute of Medical Research, P.O. Box 378, 511 Madang, Papua New Guinea. E-mail: nicolas.senn{at}gmail.com

Authors’ addresses: Nicolas Senn, P.O. Box 378, Madang 511, Papua New Guinea, Telephone: +675 852 29 09, Fax: +675 852 32 89, E-mail: nicolas.senn{at}gmail.com. Valérie D’Acremont and Pierre Landry, Travel Clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. Blaise Genton, Swiss Tropical Institute, Basel, Switzerland.

Reprint requests: Nicolas Senn, PNG Institute of Medical Research, P.O. Box 378, 511 Madang, Papua New Guinea; Telephone: +675 852 29 09, Fax: +675 852 32 89, E-mail: nicolas.senn{at}gmail.com.