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Rini EA, Weintrob AC, Tribble DR, Lloyd BA, Warkentien TE, Shaikh F, Li P, Aggarwal D, Carson ML, Murray CK. Compliance with antimalarial chemoprophylaxis recommendations for wounded United States military personnel admitted to a military treatment facility. Am J Trop Med Hyg 2014; 90:1113-6. [PMID: 24732457 PMCID: PMC4047738 DOI: 10.4269/ajtmh.13-0646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/13/2014] [Indexed: 11/07/2022] Open
Abstract
Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malaria-endemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009-August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and < 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.
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Affiliation(s)
- Elizabeth A Rini
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Amy C Weintrob
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - David R Tribble
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Bradley A Lloyd
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Tyler E Warkentien
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Faraz Shaikh
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ping Li
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Deepak Aggarwal
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - M Leigh Carson
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Clinton K Murray
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
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Keene DD, Tong JL, Roughton S, Fadden SJ. Anti-malarial chemoprophylaxis following evacuation from Afghanistan. J ROY ARMY MED CORPS 2012; 158:38-40; discussion 40. [PMID: 22545372 DOI: 10.1136/jramc-158-01-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
UK forces deployed to Afghanistan between March and November are prescribed anti-malarial chemoprophylaxis (AMC). In 2007 an audit showed poor pre-injury AMC compliance and a prescription rate of 50% amongst those casualties evacuated to Role 4. We re-audited the post-deployment AMC prescribing practice for casualties from Afghanistan for the 2008 and half of the 2009 malaria season. Using the Role 4 prescribing information and communication system (PICS), a retrospective AMC search for Proguanil, Chloroquine, Doxycycline, Mefloquine and Malarone was performed on these casualties. Only five out of 305 (1.64%) inpatients were prescribed appropriate post-deployment AMC medication. Awareness of the need to prescribe AMC following evacuation remains poor, and may be improved by recording AMC compliance in field medical records and modifying the PICS software.
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Affiliation(s)
- D D Keene
- Royal Centre for Defence Medicine, Birmingham.
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