Médecine tropicale : revue du Corps de santé colonial
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Review Randomized Controlled Trial Comparative Study Clinical Trial
Malaria prophylaxis/radical cure: recent experiences of the Australian Defence Force.
Since the eighties, the Australian Defence Force has deployed soldiers in malaria-endemic areas: Cambodia, Somalia, Rwanda, Bougainville, and East Timor. Currently, doxycycline is used as first line prophylactic drug and mefloquine is recommended for those who cannot tolerate the antibiotic. In 1998, the Australian Defence Force participated in the evaluation of tafenoquine for prophylaxis of both falciparum and vivax malaria in Thai soldiers. ⋯ Seven soldiers in each arm developed vivax malaria after returning to Australia. These results indicate that tafenoquine is not superior to primaquine in preventing vivax malaria. However study participants preferred the shorter course using tafenoquine and operationally it was found to be more suitable than primaquine.
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Soldiers on duty in tropical areas are at high risk of malaria and need chemoprophylactic regimens which may ensure the best efficacy, tolerability and compliance. Current Italian Army guidelines are based on recent military experiences in tropical areas, where mefloquine prophylaxis was as well tolerated as combination treatment with chloroquine and proguanil but more effective and easier to comply with, at least among soldiers. ⋯ Doxycycline is the first choice regimen for mefloquine-resistant areas and an alternative to mefloquine when this medication is contraindicated or not tolerated. The combination chloroquine-proguanil represents the alternative chemoprophylactic regimen when mefloquine and doxycycline are contraindicated or not tolerated.