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Compliance with Antimalarial Chemoprophylaxis Recommendations for Wounded United States Military Personnel Admitted to a Military Treatment Facility

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  • Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
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Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malaria-endemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009–August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and < 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.

Author Notes

* Address correspondence to Elizabeth A. Rini, Landstuhl Regional Medical Center, CMR 402, Box 1838, APO AE 09180-0019. E-mail: elizabeth.a.rini.mil@mail.mil

Financial support: The study (IDCRP-024) was supported by the Infectious Disease Clinical Research Program, a Department of Defense program executed through the Uniformed Services University of the Health Sciences; the National Institute of Allergy and Infectious Diseases, National Institute of Health, under Inter-Agency Agreement Y1-AI-5072; and the Department of the Navy under the Wounded, Ill, and Injured Program.

Authors' addresses: Elizabeth A. Rini, Landstuhl Regional Medical Center, CMR 402, Box 1838, APO AE 09180-0019, E-mail: elizabeth.a.rini.mil@mail.mil. Amy C. Weintrob, Walter Reed National Military Medical Center, Bethesda, MD, and Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mail: amy.c.weintrob.ctr@health.mil. David R. Tribble, Faraz Shaikh, Ping Li, Deepak Aggarwal, and M. Leigh Carson, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mails: david.tribble@usuhs.edu, fshaikh@idcrp.org, pli@idcrp.org, daggarwal@idcrp.org, and lcarson@idcrp.org. Bradley A. Lloyd and Clinton K. Murray, San Antonio Military Medical Center, Fort Sam Houston, TX, E-mails: bradley.lloyd@us.af.mil and clinton.k.murray.mil@mail.mil. Tyler E. Warkentien, Walter Reed National Military Medical Center, Bethesda, MD, E-mail: tyler.e.warkentien@health.mil.

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