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Larry Marum - One of the best experts on this subject based on the ideXlab platform.

  • Risk Factors for Malaria among Expatriates Living in Kampala, Uganda: The Need for Adherence to Chemoprophylactic Regimens
    The American journal of tropical medicine and hygiene, 1995
    Co-Authors: Tilahun Adera, Martin S. Wolfe, Karen Mcguire-rugh, Nancy Calhoun, Larry Marum
    Abstract:

    Abstract This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala, Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred, to identify potential risk factors for malaria in this population, and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6, 95% confidence interval [CI] = 1.6–27.8) and almost seven times greater than all the previous six years combined (RR = 6.8, 95% CI = 2.9–15.9). In this outbreak, children and young adults less than 20 years of age had more than a three-fold increase in risk (RR = 3.7, 95% CI = 0.7–19.8) than those in the 20–39-year-old age group. African-Americans had a six-fold increased risk compared with Caucasians (RR = 6.0, 95% CI = 1.6–22.7). Those who did not take any drug prophylaxis were 10 times more likely to develop malaria (RR = 10.0, 95% CI = 2.7–37.0) than those who took mefloquine, doxycycline, or Chloroquine Plus Proguanil. In this setting, weekly mefloquine was 82% more effective, and Chloroquine Plus Proguanil was 92% more effective than weekly Chloroquine alone. This outbreak underscores the need for compliance with appropriate chemoprophylactic regimens in preventing malaria infection.

Tilahun Adera - One of the best experts on this subject based on the ideXlab platform.

  • Copyright ©1995 by The American Society of Tropical Medicine and Hygiene RISK FACTORS FOR MALARIA AMONG EXPATRIATES LIVING IN KAMPALA, UGANDA: THE NEED FOR ADHERENCE TO CHEMOPROPHYLACTIC REGIMENS
    2016
    Co-Authors: Tilahun Adera, Martin S. Wolfe, Karen Mcguire-rugh, Calhoun Andlarry Marum
    Abstract:

    Abstract. This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala, Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred, to identify potential risk factors for malaria in this population, and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6, 95 % confidence interval [CI] = 1.6-27.8) and almost seven times greater than all the previous six years combined (RR = 6.8, 95% CI = 2.9-15.9). In this outbreak, children and young adults less than 20 years of age had more than a three-fold increase in risk (RR = 3.7, 95 % CI = 0.7-19.8) than those in the 20-39-year-old age group. African-Americans had a six-fold increased risk compared with Caucasians (RR = 6.0, 95 % CI = 1.6-22.7). Those who did not take any drug prophylaxis were 10 times more likely to develop malaria (RR = 10.0, 95 % CI = 2.7-37.0) than those who took mefloquine, doxycycline, or Chloroquine Plus Proguanil. In this setting, weekly mefloquine was 82 % more effective, and Chloroquine Plus Proguanil was 92 % more effective than weekly Chloroquine alone. This outbreak underscores the need for compliance with appropriate chemoprophylactic regimens in preventing malaria infection. Malaria is one of the most important health problems in the world, with 110 million cases occurring each year i

  • Risk Factors for Malaria among Expatriates Living in Kampala, Uganda: The Need for Adherence to Chemoprophylactic Regimens
    The American journal of tropical medicine and hygiene, 1995
    Co-Authors: Tilahun Adera, Martin S. Wolfe, Karen Mcguire-rugh, Nancy Calhoun, Larry Marum
    Abstract:

    Abstract This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala, Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred, to identify potential risk factors for malaria in this population, and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6, 95% confidence interval [CI] = 1.6–27.8) and almost seven times greater than all the previous six years combined (RR = 6.8, 95% CI = 2.9–15.9). In this outbreak, children and young adults less than 20 years of age had more than a three-fold increase in risk (RR = 3.7, 95% CI = 0.7–19.8) than those in the 20–39-year-old age group. African-Americans had a six-fold increased risk compared with Caucasians (RR = 6.0, 95% CI = 1.6–22.7). Those who did not take any drug prophylaxis were 10 times more likely to develop malaria (RR = 10.0, 95% CI = 2.7–37.0) than those who took mefloquine, doxycycline, or Chloroquine Plus Proguanil. In this setting, weekly mefloquine was 82% more effective, and Chloroquine Plus Proguanil was 92% more effective than weekly Chloroquine alone. This outbreak underscores the need for compliance with appropriate chemoprophylactic regimens in preventing malaria infection.

Eskild Petersen - One of the best experts on this subject based on the ideXlab platform.

  • the efficacy of chemoprophylaxis against malaria with Chloroquine Plus Proguanil mefloquine and atovaquone Plus Proguanil in travelers from denmark
    Journal of Travel Medicine, 2006
    Co-Authors: Kristian Kofoed, Eskild Petersen
    Abstract:

    Background The risk of malaria infection in travelers is seldom known in detail and neither is the efficacy of different prophylactic regimens, due to a lack of controlled trials. Surveillance of malaria diagnosed after return can provide data on risk and efficacy. Methods An open case-control study was initiated. Imported cases were notified to our department and were studied in 320 permanent residents in Denmark, returning from abroad with malaria from 1997 to 1999. These were compared with a group of 600 travelers who were not infected with malaria and matched by age, sex, and destination. Information on the use of chemoprophylaxis and the length of stay in malarious areas were obtained by questionnaire. Results Two hundred cases of Plasmodium falciparum malaria were notified of which 103 had used Chloroquine and Proguanil, 16 mefloquine, and 3 atovaquone and Proguanil as prophylaxis, whereas the rest had taken other drugs or no prophylaxis. This study showed that the risk increased with increasing exposure and that compliance was lower especially for mefloquine users in malaria cases compared with controls. The study provided the first comprehensive data on the use of atovaquone/Proguanil to travelers. The estimated efficacy of Chloroquine and Proguanil, mefloquine, and atovaquone and Proguanil in fully compliant users was 1:599, 1:2,232, and 1:1,943, respectively, P. falciparum cases per prescription. The country specific risk data showed that the risk of getting malaria varied from 1 per 140 travelers to Ghana to almost 1 per 40,000 to Thailand, providing data that allow the use of prophylaxis to be restricted to high-risk areas. Conclusion There was a considerable variation in risk between the countries with the highest risk in tropical Africa. Chloroquine and Proguanil was less efficient compared with mefloquine. Atovaquone/Proguanil (Malarone) was at least as efficient as mefloquine, but breakthroughs were observed.

  • reported side effects to Chloroquine Chloroquine Plus Proguanil and mefloquine as chemoprophylaxis against malaria in danish travelers
    Journal of Travel Medicine, 2006
    Co-Authors: Eskild Petersen, Tove Ronne, Anita M Ronn, Ib C Bygbjerg, Severin Olesen Larsen
    Abstract:

    Background: The aim of the study was to provide data on the relative frequency of reported symptoms in travelers using Chloroquine, Chloroquine Plus Proguanil, and mefloquine. Method: The study was an open, nonrandomized study recording self-reported events in travelers recruited consecutively from two travel clinics in Copenhagen, Denmark. The main outcome measures were the relative proportion of travelers reporting particular symptoms in the three prophylaxis groups, compliance, hospitalization and premature termination of the travel. Results: From May 1996 to April 1998 5,446 travelers were included and 4,158 questionnaires (76.3%) returned. Compliance was significantly better in mefloquine users with 83.3% of short term travelers compared to 76.3% in Chloroquine Plus Proguanil users. Also, 84.8%, 59.3% and 69.5% using Chloroquine, Chloroquine Plus Proguanil, and mefloquine respectively reported no symptoms and 0.6%, 1.1% and 2.8% reported “unacceptable” symptoms. Compared to Chloroquine, mefloquine users had a significantly higher risk of reporting depression, RR 5.06 (95% CI 2.71 - 9.45), “strange thoughts,” RR 6.36 (95% CI 2.52 - 16.05) and altered spatial perception, RR 3.00 (95% CI 1.41 - 6.41). Conclusion: Overall mefloquine is tolerated at least as well as Chloroquine Plus Proguanil and shows better compliance, however, symptoms related to the central nervous system are more prevalent in mefloquine users and when symptoms develop, they are perceived as more severe.

  • Malaria chemoprophylaxis: when should we use it and what are the options?
    Expert review of anti-infective therapy, 2004
    Co-Authors: Eskild Petersen
    Abstract:

    Malaria chemoprophylaxis concerns prescribing healthy individuals medication for an infection they have an unknown chance of getting. Sensible use of malaria chemoprophylaxis is a balance between the risk of infection and death, and the risk of side effects. The risk of infection can be broken down into the risk of being bitten by a malaria-infected mosquito and the risk of the malaria parasites being resistant to the drug used for prophylaxis. Our knowledge of these parameters is patchy. The risk of infection is not uniform at a given location and the standard of living will greatly influence risk. It is suggested that chemoprophylaxis should not be recommended in areas with less than ten reported cases of P. falciparum malaria per 1000 inhabitants per year. The resistance pattern is known to a certain extent but, for instance, diverging opinion of how much resistance to Chloroquine there is in West Africa illustrates the lack of data. There is much debate on rare adverse events, which usually escape Phase III studies prior to registration and are only picked up by passive, postmarketing surveillance. The lessons over the past 20 years with the introduction of amodiaquine, pyrimethamine/dapsone (Maloprim, GlaxoSmithKline) and pyrimethamine/sulfadoxine (Fansidar, Roche), which were all withdrawn for prophylaxis after a few years, show how sensitive drugs for chemoprophylaxis are to side effects. Three levels of chemoprophylaxis are used: Chloroquine in areas with sensitive P. falciparum, Chloroquine Plus Proguanil in areas with low level Chloroquine resistance, and atovaquone/Proguanil (Malarone, GlaxoSmithKline), doxycycline or mefloquine (Lariam, Roche) in areas with extensive resistance against Chloroquine and Proguanil. Primaquine and the primaquone analog tafenoquine may be future alternatives but otherwise there are few new drugs for chemoprophylaxis on the horizon.

Lesley J. Scott - One of the best experts on this subject based on the ideXlab platform.

  • atovaquone Proguanil a review of its use for the prophylaxis of plasmodium falciparum malaria
    Drugs, 2003
    Co-Authors: Kate Mckeage, Lesley J. Scott
    Abstract:

    Atovaquone/Proguanil is a fixed-dose combination tablet of two antimalarial agents and is highly effective for the prevention of Plasmodium falciparum malaria. In combination with Proguanil, the ability of atovaquone to inhibit parasitic mitochondrial electron transport is markedly enhanced. Both atovaquone and Proguanil are active against hepatic (pre-erythrocytic) stages of P. falciparum, thereby providing causal prophylaxis and eliminating the need to continue post-travel treatment beyond 7 days. Both agents are also active against erythrocytic stages of P. falciparum, thereby providing suppressive prophylaxis. Atovaquone/Proguanil is highly effective against drug-resistant strains of P. falciparum, and cross-resistance has not been observed between atovaquone and other antimalarial agents. In comparative, randomised clinical trials, there were no cases of P. falciparum malaria in nonimmune adults, adolescents and children (>/=11 kg) visiting malaria-endemic regions for /=11 kg) from endemic regions who may carry some immunity to malaria (semi-immune), the prophylactic efficacy rating for atovaquone/Proguanil based on placebo-controlled trials was 95-100%. Atovaquone/Proguanil is generally well tolerated by both adults and children. The most common treatment-related adverse events in placebo-controlled trials were headache and abdominal pain, which occurred at a rate similar to that observed with placebo. Atovaquone/Proguanil therapy was associated with significantly fewer gastrointestinal adverse events than Chloroquine Plus Proguanil, and significantly fewer neuropsychiatric adverse events than mefloquine in nonimmune individuals. Significantly fewer recipients of atovaquone/Proguanil discontinued treatment because of adverse events than individuals receiving Chloroquine Plus Proguanil or mefloquine (p Conclusion Atovaquone/Proguanil is a fixed-dose combination antimalarial tablet that provides effective prophylaxis of P. falciparum malaria, including drug-resistant strains. Both atovaquone and Proguanil are effective against hepatic stages of P. falciparum, which means that treatment need only continue for 7 days after leaving a malaria-endemic region. Atovaquone/Proguanil was generally well tolerated and was associated with fewer gastrointestinal adverse events than Chloroquine Plus Proguanil, and fewer neuropsychiatric adverse events than mefloquine. Thus, atovaquone/Proguanil provides effective prophylaxis of P. falciparum malaria and compared with other commonly used antimalarial agents has an improved tolerability profile, and, overall, a more convenient dosage regimen, particularly in the post-travel period.

  • Atovaquone/Proguanil: a review of its use for the prophylaxis of Plasmodium falciparum malaria.
    Drugs, 2003
    Co-Authors: Kate Mckeage, Lesley J. Scott
    Abstract:

    Atovaquone/Proguanil is a fixed-dose combination tablet of two antimalarial agents and is highly effective for the prevention of Plasmodium falciparum malaria. In combination with Proguanil, the ability of atovaquone to inhibit parasitic mitochondrial electron transport is markedly enhanced. Both atovaquone and Proguanil are active against hepatic (pre-erythrocytic) stages of P. falciparum, thereby providing causal prophylaxis and eliminating the need to continue post-travel treatment beyond 7 days. Both agents are also active against erythrocytic stages of P. falciparum, thereby providing suppressive prophylaxis. Atovaquone/Proguanil is highly effective against drug-resistant strains of P. falciparum, and cross-resistance has not been observed between atovaquone and other antimalarial agents. In comparative, randomised clinical trials, there were no cases of P. falciparum malaria in nonimmune adults, adolescents and children (>/=11 kg) visiting malaria-endemic regions for /=11 kg) from endemic regions who may carry some immunity to malaria (semi-immune), the prophylactic efficacy rating for atovaquone/Proguanil based on placebo-controlled trials was 95-100%. Atovaquone/Proguanil is generally well tolerated by both adults and children. The most common treatment-related adverse events in placebo-controlled trials were headache and abdominal pain, which occurred at a rate similar to that observed with placebo. Atovaquone/Proguanil therapy was associated with significantly fewer gastrointestinal adverse events than Chloroquine Plus Proguanil, and significantly fewer neuropsychiatric adverse events than mefloquine in nonimmune individuals. Significantly fewer recipients of atovaquone/Proguanil discontinued treatment because of adverse events than individuals receiving Chloroquine Plus Proguanil or mefloquine (p Conclusion Atovaquone/Proguanil is a fixed-dose combination antimalarial tablet that provides effective prophylaxis of P. falciparum malaria, including drug-resistant strains. Both atovaquone and Proguanil are effective against hepatic stages of P. falciparum, which means that treatment need only continue for 7 days after leaving a malaria-endemic region. Atovaquone/Proguanil was generally well tolerated and was associated with fewer gastrointestinal adverse events than Chloroquine Plus Proguanil, and fewer neuropsychiatric adverse events than mefloquine. Thus, atovaquone/Proguanil provides effective prophylaxis of P. falciparum malaria and compared with other commonly used antimalarial agents has an improved tolerability profile, and, overall, a more convenient dosage regimen, particularly in the post-travel period.

Martin S. Wolfe - One of the best experts on this subject based on the ideXlab platform.

  • Copyright ©1995 by The American Society of Tropical Medicine and Hygiene RISK FACTORS FOR MALARIA AMONG EXPATRIATES LIVING IN KAMPALA, UGANDA: THE NEED FOR ADHERENCE TO CHEMOPROPHYLACTIC REGIMENS
    2016
    Co-Authors: Tilahun Adera, Martin S. Wolfe, Karen Mcguire-rugh, Calhoun Andlarry Marum
    Abstract:

    Abstract. This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala, Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred, to identify potential risk factors for malaria in this population, and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6, 95 % confidence interval [CI] = 1.6-27.8) and almost seven times greater than all the previous six years combined (RR = 6.8, 95% CI = 2.9-15.9). In this outbreak, children and young adults less than 20 years of age had more than a three-fold increase in risk (RR = 3.7, 95 % CI = 0.7-19.8) than those in the 20-39-year-old age group. African-Americans had a six-fold increased risk compared with Caucasians (RR = 6.0, 95 % CI = 1.6-22.7). Those who did not take any drug prophylaxis were 10 times more likely to develop malaria (RR = 10.0, 95 % CI = 2.7-37.0) than those who took mefloquine, doxycycline, or Chloroquine Plus Proguanil. In this setting, weekly mefloquine was 82 % more effective, and Chloroquine Plus Proguanil was 92 % more effective than weekly Chloroquine alone. This outbreak underscores the need for compliance with appropriate chemoprophylactic regimens in preventing malaria infection. Malaria is one of the most important health problems in the world, with 110 million cases occurring each year i

  • Risk Factors for Malaria among Expatriates Living in Kampala, Uganda: The Need for Adherence to Chemoprophylactic Regimens
    The American journal of tropical medicine and hygiene, 1995
    Co-Authors: Tilahun Adera, Martin S. Wolfe, Karen Mcguire-rugh, Nancy Calhoun, Larry Marum
    Abstract:

    Abstract This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala, Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred, to identify potential risk factors for malaria in this population, and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6, 95% confidence interval [CI] = 1.6–27.8) and almost seven times greater than all the previous six years combined (RR = 6.8, 95% CI = 2.9–15.9). In this outbreak, children and young adults less than 20 years of age had more than a three-fold increase in risk (RR = 3.7, 95% CI = 0.7–19.8) than those in the 20–39-year-old age group. African-Americans had a six-fold increased risk compared with Caucasians (RR = 6.0, 95% CI = 1.6–22.7). Those who did not take any drug prophylaxis were 10 times more likely to develop malaria (RR = 10.0, 95% CI = 2.7–37.0) than those who took mefloquine, doxycycline, or Chloroquine Plus Proguanil. In this setting, weekly mefloquine was 82% more effective, and Chloroquine Plus Proguanil was 92% more effective than weekly Chloroquine alone. This outbreak underscores the need for compliance with appropriate chemoprophylactic regimens in preventing malaria infection.