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Controversias y conceptos erróneos en la quimioprofilaxis de la malaria para viajeros
Lin H Chen1, Mary E Wilson, Patricia Schlagenhauf
1Travel Medicine Center, Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA 02238, USA. lchen@hms.harvard.edu
JAMA
|May 24, 2007
Resumen
Las pautas para la quimioprofilaxis de la malaria varían, con la mefloquina mostrando una seguridad comparable a otras drogas. La primaquina es eficaz contra las recaídas de Plasmodium vivax, sin embargo, las directrices actuales carecen de consenso.
Área de la Ciencia:
- Medicina tropical y enfermedades infecciosas.
- Salud global y epidemiología.
- Farmacología y seguridad de los medicamentos.
Sus antecedentes:
- Las controversias en la prevención de la malaria se derivan de las brechas de datos, las pruebas contradictorias y los diferentes umbrales de riesgo.
- Los conceptos erróneos con respecto a la gravedad de la malaria, la tolerabilidad de los medicamentos y la eficacia repelente alimentan los debates sobre la prevención.
Objetivo del estudio:
- Para comparar las directrices internacionales para la quimioprofilaxis de la malaria e identificar discrepancias en las recomendaciones.
- Revisar la tolerabilidad de la mefloquina, centrándose en los efectos neuropsiquiátricos y el impacto en el rendimiento.
- Examinar el fracaso de los regímenes actuales para prevenir las recaídas de malaria Plasmodium vivax y explorar alternativas.
Principales métodos:
- Búsqueda sistemática de la literatura de MEDLINE/PubMed hasta diciembre de 2006.
- Las palabras clave incluían malaria, quimioprofilaxis, viajes, mefloquina, eventos adversos neuropsiquiátricos, tolerabilidad, malaria vivax y primaquina.
- También se revisaron las referencias de artículos seleccionados sin restricciones lingüísticas.
Principales resultados:
- Existen brechas y conflictos significativos entre las directrices actuales de quimioprofilaxis de la malaria con respecto a la elección de fármacos y la duración de la profilaxis.
- Los estudios controlados indican que las tasas de eventos adversos neuropsiquiátricos graves de la mefloquina son comparables a otras drogas y no afectan el rendimiento.
- La quimioprofilaxis actual de primera línea no puede prevenir las recaídas de Plasmodium vivax, mientras que la primaquina demuestra eficacia en la prevención de estas recaídas.
Conclusiones:
- La prevención eficaz de la malaria para los viajeros requiere comprender la epidemiología y las interacciones huésped-parásito.
- La falta de recomendaciones estandarizadas y las controversias persistentes complican las estrategias de prevención de la malaria.
- Un consenso internacional es crucial para conciliar las directrices, abordar las controversias y mejorar la adhesión a las medidas preventivas.
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