Compliance with antimalarial chemoprophylaxis recommendations for wounded United States military personnel admitted to a military treatment facility

Abstract

Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malaria-endemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009-August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and < 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.

Figure 1.

Antimalarial primary chemoprophylaxis flow diagram for United States Military trauma patients from Afghanistan admitted during June 1, 2009–August 31, 2011. LRMC = Landstuhl Regional Medical Center; TIDOS = Trauma Infectious Disease Outcomes Study; MTF = military treatment facility; BAMC = Brooke Army Medical Center; WRAMC = Walter Reed Army Medical Center; NNMC = National Naval Medical Center.