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FORMULARY FORUM

Atovaquone-Proguanil for Prophylaxis and Treatment of Malaria

Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Director of Pharmacy and Vaccine Services, British Columbia Centre for Disease Control, Vancouver

James R Salzman, MD DTM&H (London)

Clinical Instructor, Department of Family Practice, University of British Columbia; Communicable Disease Consultant, Vancouver Coastal Health Authority, Vancouver

Mary HH Ensom, PharmD FASHP FCCP FCSHP

Professor, Faculty of Pharmaceutical Sciences, University of British Columbia; Clinical Pharmacy Specialist, Department of Pharmacy, Childrenís & Womenís Health Centre of British Columbia, Vancouver

Reprints: Fawziah Marra PharmD FSCHP, Pharmacy and Vaccine Services, BC Centre for Disease Control, 655 W. 12th Ave., Vancouver, BC V5Z 4R4, Canada, FAX 604/775-2718, fawziah.marra{at}bccdc.ca

OBJECTIVE: To review the currently available information on atovaquone-proguanil for treatment and prophylaxis of malaria.

DATA SOURCES: A MEDLINE search was conducted from 1966 to February 2003 using key phrases Malarone, atovaquone, proguanil, and malaria. Further articles were identified from a manual search of the references of identified articles.

STUDY SELECTION AND DATA EXTRACTION: English-language studies with animal and human data evaluating preclinical pharmacology, human studies on pharmacokinetics, and clinical trials were evaluated. Relevant data were extracted from identified articles.

DATA SYNTHESIS: Atovaquone-proguanil has been evaluated for treatment of acute, uncomplicated malaria caused by Plasmodium falciparum in 8 clinical trials. In these studies, treatment with atovaquone-proguanil led to a higher (87ñ100% vs. 72ñ88%) or equally effective (94ñ100% vs. 90ñ100%) cure rate than the comparator antimalarial agents. Atovaquone-proguanil has been evaluated for prophylaxis of malaria in 6 clinical trials. In the 4 placebo-controlled trials for semi-immune residents or nonimmune migrants, the prophylaxis success rates in the atovaquone-proguanil and placebo arms ranged from 98% to 100% and 48% to 82%, respectively. The prophylaxis with success rates were similar among the 2 arms when atovaquone-proguanil was compared with other antimalarial regimens in nonimmune travelers. Atovaquone-proguanil was well tolerated in these clinical trials.

CONCLUSIONS: Atovaquone-proguanil is a safe and effective alternative to current recommended regimens for prophylaxis and treatment of malaria.

Key Words: antimalarial drugs, atovaquone-proguanil, malaria

Published Online, June 23, 2003. www.theannals.com, DOI 10.1345/aph.1C473

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-025-H01

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