Journal Article

Efficacy and Safety of Atovaquone/Proguanil as Suppressive Prophylaxis for <i>Plasmodium falciparum</i> Malaria

G. Dennis Shanks, Daniel M. Gordon, Francis W. Klotz, Gladys M. Aleman, Aggrey J. Oloo, Deborah Sadie and Trevor R. Scott

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 3, pages 494-499
Published in print September 1998 | ISSN: 1058-4838
Published online September 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514710
Efficacy and Safety of Atovaquone/Proguanil as Suppressive Prophylaxis for Plasmodium falciparum Malaria

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Currently recommended prophylactic regimens for Plasmodium falciparum malaria are associated with a high incidence of adverse events and/or suboptimal efficacy. In a double-blind, placebo-controlled, randomized clinical trial in western Kenya, adult volunteers received a treatment course of atovaquone/proguanil hydrochloride (250 mg/100 mg per tablet) to eliminate preexisting infection. Immediately thereafter, subjects were randomized to one of the three prophylactic regimens to receive one atovaquone/proguanil tablet daily (n = 68), two atovaquone/proguanil tablets daily (n = 65), or placebo (n = 65) for 10 weeks. The study endpoint for any subject was the development of parasitemia, evident on blood smear, during prophylaxis. Of the evaluable subjects, all in the low-dose (54 of 54) and high-dose (54 of 54) atovaquone/proguanil groups remained malaria-free during the 10-week prophylaxis period, in contrast to only 48% (26 of 54) in the placebo group (P < .001). Both atovaquone/proguanil prophylactic regimens were as well tolerated as placebo. Thus, atovaquone/proguanil appears to be highly efficacious and safe as prophylaxis for P. falciparum malaria.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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