6% of cases, a figure that is consistent with estimates of 6 to 1

6% of cases, a figure that is consistent with estimates of 6 to 11% reported Gefitinib in three previous studies from France, the United States, and Canada,5,20,22 but better than the 26 to 27% observed in two other studies from Canada3 and the United States21 (Table 2). We observed statistically significantly fewer incorrect uses of anti-malarials in the treatment

of patients with diagnosis of P falciparum infection (3.9%) than in the treatment of P vivax (29.1%), a data consistent with the results of the studies of Kain, Singh, and Ranque.3,5,21 However, in a study from the United States, incorrect use in anti-malarial therapy was much more frequent in the treatment of P falciparum infection.20 Inappropriate initial anti-malarial therapy is of great concern especially in the case of P falciparum malaria as this infection may run a life-threatening Pictilisib mw course. In our study, all the errors made in the treatment

of P falciparum infection should be considered serious errors as they regarded the selection of the wrong drug relative to the travel history (ie, chloroquine for patients coming from areas of chloroquine-resistance) or to the inappropriate consideration of the clinical presentation (ie, the use of mefloquine in patients with signs, or laboratory evidence of, severe malaria). In the three series reporting errors in anti-malarial therapy, we have calculated that serious treatment errors occurred, respectively, in CYTH4 5.4%,21

17.2%,20 and 18%3 of P falciparum infections. Even though two studies have clearly demonstrated that receiving inappropriate initial anti-malarial treatment was significantly associated with treatment employed at community hospital3 or to the absence of infectious disease specialist consultation,21 our present experience highlights that these errors occur also in a highly specialized setting. Moreover, our study shows that although almost 76% (222/291) of patients received four appropriate regimens (ie, mefloquine, quinine, quinine + doxycycline, and chloroquine + primaquine) the remaining patients were treated with nine different regimens; however, similar results are observed reviewing the published papers on malaria in travelers when treatment is detailed.3,5,20–22 In our experience, this unacceptable high variability of the drug regimen chosen is probably the consequence of the high number of physicians in charge, together with the absence of in-house “user-friendly” treatment guidelines. In our study, mefloquine was the most frequently employed drug for the treatment of uncomplicated P falciparum malaria with an overall frequency of adverse effects documented in 19.5% of patients. Although our study was retrospective and not specifically addressed to evaluate tolerance, mefloquine was generally well-tolerated, with only one case of drug discontinuation. This is in contrast with the results of a French multicenter study showing a 4.

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