Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review

Detalhes bibliográficos
Autor(a) principal: Savelkoel, Jelmer
Data de Publicação: 2018
Outros Autores: Binnendijk, Klaas Hendrik, Spijker, Rene, van Vugt, Michèle, Tan, Kathrine, Hanscheid, Thomas, Schlagenhauf, Patricia, Grobusch, Martin Peter
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10451/59480
Resumo: © 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/)
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spelling Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic reviewAtovaquone-proguanilAbbreviated regimeChemoprophylaxisSystematic review© 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/)Background: We evaluated existing data on the prophylactic efficacy of atovaquone-proguanil (AP) in order to determine whether prophylaxis in travellers can be discontinued on the day of return from a malaria-endemic area instead of seven days after return as per currently recommended post-travel schedule. Methods: PubMed and Embase databases were searched to identify relevant studies. This PROSPERO-registered systematic review followed PRISMA guidelines. The search strategy included terms or synonyms relevant to AP combined with terms to identify articles relating to prophylactic use of AP and inhibitory and half-life properties of AP. Studies considered for inclusion were: randomized controlled trials, cohort studies, quasi-experimental studies, open-label trials, patient-control studies, cross-sectional studies; as well as case-series and non-clinical studies. Data on study design, characteristics of participants, interventions, and outcomes were extracted. Primary outcomes considered relevant were prophylactic efficacy and prolonged inhibitory activity and half-life properties of AP. Results: The initial search identified 1,482 publications, of which 40 were selected based on screening. Following full text review, 32 studies were included and categorized into two groups, namely studies in support of the current post-travel regimen (with a total of 2,866 subjects) and studies in support of an alternative regimen (with a total of 533 subjects). Conclusion: There is limited direct and indirect evidence to suggest that an abbreviated post-travel regimen for AP may be effective. Proguanil, however, has a short half-life and is essential for the synergistic effect of the combination. Stopping AP early may result in mono-prophylaxis with atovaquone and possibly select for atovaquone-resistant parasites. Furthermore, the quality of the studies in support of the current post-travel regimen outweighs the quality of the studies in support of an alternative short, post-travel regimen, and the total sample size of the studies to support stopping AP early comprises a small percentage of the total sample size of the studies performed to establish the efficacy of the current AP regimen. Additional research is required - especially from studies evaluating impact on malaria parasitaemia and clinical illness and conducted among travellers in high malaria risk settings - before an abbreviated regimen can be recommended in current practice. Prospero registration number: CRD42017055244.ElsevierRepositório da Universidade de LisboaSavelkoel, JelmerBinnendijk, Klaas HendrikSpijker, Renevan Vugt, MichèleTan, KathrineHanscheid, ThomasSchlagenhauf, PatriciaGrobusch, Martin Peter2023-09-26T14:10:18Z20182018-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10451/59480engTravel Medicine and Infectious Disease 21 (2018) 3–201477-893910.1016/j.tmaid.2017.12.0051873-0442info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-08T17:08:38Zoai:repositorio.ul.pt:10451/59480Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T22:09:23.478228Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
title Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
spellingShingle Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
Savelkoel, Jelmer
Atovaquone-proguanil
Abbreviated regime
Chemoprophylaxis
Systematic review
title_short Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
title_full Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
title_fullStr Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
title_full_unstemmed Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
title_sort Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: a systematic review
author Savelkoel, Jelmer
author_facet Savelkoel, Jelmer
Binnendijk, Klaas Hendrik
Spijker, Rene
van Vugt, Michèle
Tan, Kathrine
Hanscheid, Thomas
Schlagenhauf, Patricia
Grobusch, Martin Peter
author_role author
author2 Binnendijk, Klaas Hendrik
Spijker, Rene
van Vugt, Michèle
Tan, Kathrine
Hanscheid, Thomas
Schlagenhauf, Patricia
Grobusch, Martin Peter
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório da Universidade de Lisboa
dc.contributor.author.fl_str_mv Savelkoel, Jelmer
Binnendijk, Klaas Hendrik
Spijker, Rene
van Vugt, Michèle
Tan, Kathrine
Hanscheid, Thomas
Schlagenhauf, Patricia
Grobusch, Martin Peter
dc.subject.por.fl_str_mv Atovaquone-proguanil
Abbreviated regime
Chemoprophylaxis
Systematic review
topic Atovaquone-proguanil
Abbreviated regime
Chemoprophylaxis
Systematic review
description © 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/)
publishDate 2018
dc.date.none.fl_str_mv 2018
2018-01-01T00:00:00Z
2023-09-26T14:10:18Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10451/59480
url http://hdl.handle.net/10451/59480
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Travel Medicine and Infectious Disease 21 (2018) 3–20
1477-8939
10.1016/j.tmaid.2017.12.005
1873-0442
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
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