Utilisation of malaria prophylaxis: the effect of changes in guidelines in The Netherlands, 1993-1998

The increase in international travelling from temperate zones to tropical countries and increasing drug resistance of Plasmodium falciparum has resulted in a growing number of travellers that are at risk for contracting malaria. The objective of this study was to obtain insight into dispensing patterns of malaria chemoprophylaxis and to determine whether health care providers have followed changes in guidelines.

Data on prescriptions of proguanil and mefloquine were obtained from the Dutch 'Foundation for Pharmaceutical Statistics' (SFK) covering the period 1 January 1993 up to 31 December 1998. From Statistics Netherlands (SN), we obtained the number of travellers to endemic areas during the years 1994-1998.

There were 420,963 prescriptions for mefloquine and 464,904 for proguanil dispensed during the study period. The total number of prescriptions for malaria chemoprophylaxis increased during the period 1993-1997 from 98,325 (of which 14,427 (14.7%) for mefloquine and 83,898 (85.3%) for proguanil) to 168,452 (of which 90,232 (53.6%) for mefloquine and 78,220 (46.4%) for proguanil). The number of prescriptions per 1000 travellers decreased over the years for proguanil from 169 to 118 but remained stable for mefloquine at 126. The average duration for which mefloquine was prescribed remained stable, whereas the average duration for which proguanil was prescribed decreased over time. We observed differences in the prescription rate of prescriptions for mefloquine between geographical regions in the Netherlands.

Changes in the guidelines of malaria prophylaxis with respect to type and duration were generally followed by health care providers. Nevertheless there are variations between the regions in the proportion of prescribed courses of mefloquine.