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

Abstract

Abstract. Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malariaendemic 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.During the past decade, United States military personnel have been deployed to Afghanistan, where malaria remains a serious health threat. Approximately 77% of the Afghan population resides in areas at risk of disease transmission, which results in an estimated annual average of 77,000 cases per year.

Oral, ultra–long-lasting drug delivery: Application toward malaria elimination goals

“…Figure 5B shows the tradeoff between the ivermectin-effect duration and the campaign coverage that achieve about the same population-wide effect in a nonseasonal setting. Although malaria prevalence can be greatly reduced by MDA with artemisinin combination therapy alone if coverage is very high (~90%), we predict that incorporating long-lasting ivermectin can achieve similar results at more modest and historically and operationally achievable levels of population-wide MDA coverage (13,(15)(16)(17)(18). With the inclusion of long-acting ivermectin, we have the added benefit that transmission from nontreated individuals is reduced because there are fewer mosquitoes to become infected, and any mosquitoes picking up infectious parasites from these untreated individuals are likely to take one or more blood meals from ivermectin-treated individuals, and thus die, before becoming infectious themselves.…”

“…The effectiveness of MDA depends on obtaining sufficient and prolonged drug blood levels in the vast majority of the population, which can be difficult in resource-constrained or remote locations, and increases the cost of the MDA approach (13,15). Nonadherence, a well-recognized barrier to effective care in the developed world, has also been shown to contribute to MDA failure in the developing world during repeat dosing regimens (16)(17)(18).…”

Lack of doxycycline antimalarial prophylaxis impact on Staphylococcus aureus tetracycline resistance

“…Studies have indicated that compliance with primary antimalarial prophylaxis among deployed soldiers ranges from 38 to 61% (Brisson et al, 2012; Kotwal et al, 2005; Newton et al, 1994; Whitman et al, 2010). Moreover, 74% of military personnel wounded in Afghanistan and evacuated to Landstuhl Regional Medical Center (LRMC; Germany) were prescribed doxycycline by clinicians in order to comply with antimalarial prophylaxis guidelines (Rini et al, 2014). While prophylaxis is warranted when serving in malaria-endemic regions, there are unavoidable consequences of extensive use of doxycycline, including potential for increased tetracycline resistance among S. aureus .…”

Convergence for Translation: Drug‐Delivery Research in Multidisciplinary Teams

“…[9] However,the effectiveness of MDA depends on achieving high enough blood levels in the majority of people in the community.Lack of drug adherence has been acritical issue in the developing world. [10,11] To this end, we sought to develop as ingle-dose administration of ivermectin which can amplify MDAc ampaigns because of its toxicity to the Anopheles mosquito that transmits malaria. [12] Thec hallenge was to develop an oral system that might last for at least two weeks and deliver ivermectin over this duration.…”