Letters

Prophylaxis against malaria

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6990.1329 (Published 20 May 1995) Cite this as: BMJ 1995;310:1329
  1. Vivien Hollyoak
  1. Consultant in communicable disease control County Durham Health Commission, Durham DH1 5XZ

    EDITOR,—Santanu Chatterjee expresses concern about the advice given on prophylaxis against malaria, especially to young people travelling for long periods on low budgets.1 Almost a quarter of 452 foreign travellers studied by Chatterjee in Calcutta were not taking any prophylaxis against malaria. The reasons for this are not reported.

    Regulations amending the NHS (General Medical Services) Regulations 1992, which came into effect in England and Wales on 6 February this year, gave general practitioners the power to charge patients for prescribing or providing drugs for prophylaxis against malaria for travel abroad.2 This means that private prescription forms will now have to be used to prescribe drugs for prophylaxis against malaria if the drugs cannot be obtained over the counter. The table gives the costs to the patient of a six week course of each of the recommended drug regimens for prophylaxis.

    The cost of chemoprophylaxis against malaria for travellers, especially those with low budgets, may be a barrier to their taking any or the most appropriate chemoprophylaxis. For example, the increasing prevalence of strains of Plasmodium falciparum resistant to chloroquine and proguanil, the cheaper antimalarials, has resulted in mafloquine, which is much more costly, being recommended as the drug of choice for travel to east and central Africa.3 Of the 3551 cases of malaria reported in the United Kingdom during 1992 and 1993, 1983 were due to P falciparum. Fourteen of these 1983 patients died, 12 of whom had contracted the disease in Africa and two in India.4 Eight of the 14 patients who died had taken no prophylaxis at all.

    If the cost to travellers of chemoprophylaxis against malaria has been a barrier to any or the most appropriate chemoprophylaxis being taken in the past then the recent changes to regulations may result in an increased number of cases of falciparum malaria being imported into England and Wales, with a resultant increase in the number of deaths from the disease. The short term savings to the NHS resulting from the change in the regulations may be short sighted.

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