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• W1689596948 abstract "As in any other field of medicine, how much evidence do we need in travel medicine before we change daily practice and adapt guidelines and recommendations for prophylaxis or treatment, for example regarding malaria? Leshem and colleagues, rightfully stating that adherence to antimalarial chemoprophylaxis (in this case to atovaquone‐proguanil—AP) may leave room for improvement, and that findings (evidence!) from clinical and pharmacokinetic studies informed such a bold move, put a shortened AP oral chemoprophylactic scheme to the test. Following intake of this regimen—in standard dosage, but only administered from the day before departure up to the day after return—outcomes were surveyed at 6 months post‐travel, resulting in the conclusion that cessation of drug intake straight after return may convey full protection compared to a standard +7 days post‐exposure regimen.1Correctly taken for the purpose of chemoprophylaxis, suitable antimalarials are considered as being of high efficacy. The problem, however, often is a reduced effectiveness, to which noncompliance (the definition in my view encompassing also not even embarking on a recommended regimen) or nonadherence (not appropriately seeing through the intake of a begun regimen) is a major contributor, as pointed out by Rombo and colleagues in this issue.2Leshem and colleagues assume a high level of adherence, although their study was not designed to assess it systematically.1 While the authors acknowledge several of the methodological shortcomings (possibly problematic choice of region with limited risk of exposure, insufficient level of evidence that the drugs were taken appropriately, possible recall bias), they suggest that travelers may discontinue AP prophylaxis 1 day after leaving endemic areas, and recommend their approach for further evaluation.In earlier days, what we would now consider as limited evidence may have led to major practice change, as exemplified by the introduction of primaquine for treatment and prophylaxis of vivax … Corresponding Author: Professor Martin P. Grobusch, MD, PhD, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22600 1100 DD Amsterdam, The Netherlands. E‐mail: m.p.grobusch{at}amc.uva.nl" @default.
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• W1689596948 date "2014-03-01" @default.
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• W1689596948 title "Malaria Chemoprophylaxis With Atovaquone‐Proguanil: Is a Shorter Regimen Fully Protective?" @default.
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• W1689596948 doi "https://doi.org/10.1111/jtm.12100" @default.
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