Letter to the editor of travel medicine and infectious disease.

摘要

We note the paper by Zuckerman et al indicating that, in preventing malaria in UK travellers, the estimated effectiveness of atovaquone/proguanil (A/P) substantially exceeded that of doxycyline (DOX) and of mefloquine (MEF). While the conclusion might (or might not) be valid, we are vexed by several issues, some of which are mentioned in the limitations section of the article; these concerns lead us to seriously question the conclusion. The data used in the article may not be representative of the "real world": data about prophylaxis are only available for 55% of all the cases of malaria; data about prescriptions are only from 121 general practitioners, which is an unstated fraction of all the GPs in the CSD UK database; as mentioned in the article, prescribing data are only from the GP sample and don't include other prescribing sources (e.g. travel health clinics); and, as mentioned in the article, there is no accounting for whether a prescription was actually dispensed or not (and there may be differential filling of prescriptions, e.g. based on cost with A/P particularly more expensive than MEF or DOX).