Trends in Antimalarial Prescriptions in Australia 2002 to 2005

Abstract

Prescribing patterns of antimalarial drugs have previously been observed to vary considerably in Australia. The aim of this study was to investigate the trends in prescription of antimalarial drugs recommended for chemoprophylaxis in Australia from 2002 to 2005. In 2007, data were extracted from the online Australian Statistics on Medicines reports published by the Pharmaceutical Benefits Advisory Committee, Drug Utilization Sub-Committee on antimalarials used in Australia for the period 2002 to 2005. Doxycycline probably remains the malaria chemoprophylaxis of choice prescribed for Australians visiting multiple drug-resistant malarious areas. Over the past 15 years, there has been a marked drop in the prescription of less useful antifolate drugs, such as pyrimethamine-containing antimalarial drugs. There has also been a reduction in the number of prescriptions of chloroquine and proguanil, although the downward trend in prescriptions of mefloquine appears to have arrested and has trended upward. The number of prescriptions of atovaquone and proguanil has been increasing dramatically, particularly since inclusion of this combination antimalarial in the prevailing Australian guidelines. Artemether plus lumefantrine combination is now available, but it is used in relatively small quantities. The prescription of the antimalarial drugs, proguanil, chloroquine, and the pyrimethamine-containing compounds, has generally reduced in number. Prescription of mefloquine trended upward during 2002 to 2005, following a period of reducing prescriptions. The atovaquone plus proguanil combination has steadily increased in use and is presumably displacing older antimalarials. The use of quinine has halved, which might be related in part to the uptake of newer antimalarial drugs for treatment. Trends in antimalarial use may be influenced by a number of factors, including the availability of antimalarials, increasing resistance, the issuing of updated guidelines for malaria chemoprophylaxis, and continuing education.