Mefloquine prescriptions increased by 38% from 2005 to 2008 before decreasing by 17% from 2008 to 2009. The number of prescriptions for atovaquone plus proguanil has trebled during the period. Prescriptions for proguanil have dropped over 90% from 2005 to 2009. The diaminopyrimidines, pyrimethamine-containing antimalarials, have mostly been removed from the prescription drug list. Prescriptions for chloroquine have reduced by 66% from 2005 to 2008 and chloroquine was only available on special access from 2009. Artemether

plus lumefantrine combination has been used learn more in relatively small quantities and only on special authority from 2007 to 2009. Quinine prescriptions have fallen by 60%. Although a considerable quantity of doxycycline

was prescribed, it was unknown how much was intended for malaria chemoprophylaxis. The prescription of antimalarials in Australia was consistent with the national guidelines with the most commonly prescribed antimalarials being atovaquone plus proguanil, mefloquine, and most likely doxycycline. Other antimalarials previously used for chemoprophylaxis have continued to be removed Opaganib cost from the prescriber list between 2005 and 2009. The prescriptions of quinine may be becoming displaced by newer antimalarial drugs for treatment, but this needs further investigation. It was reported that there were 216 million cases of malaria worldwide in 2011, resulting in approximately 655,000 deaths.[1] Australia has been declared malaria-free since 1981; however, during the period 2005 to 2009, 3,411 cases of imported malaria (average = 682/y) were notified in Australia (Figure 1).[2-6] Malaria due to Plasmodium falciparum accounted for nearly half of recorded Cyclooxygenase (COX) cases in Australia during this period.[2-6] Fortunately, deaths due to malaria in Australia are relatively

rare with only one death reported in a study of 482 cases of imported malaria in Western Australia from 1990 to 2001,[7] and none were reported for the period 2005 to 2009.[2-6] It is known that taking chemoprophylaxis decreases the severity and frequency of death from malaria due to P falciparum compared to those who take no prophylaxis.[8] A comprehensive review of malaria in Australia has been published elsewhere.[9] Therapeutic Guidelines-Antibiotic, updated every few years in Australia, provide recommendations on the selection of malaria chemoprophylaxis and treatment.[10, 11] Previous studies in Australia have suggested that trends in the prescription of antimalarials are influenced by various factors, including the prevailing malaria chemoprophylaxis guidelines in Australia.[12, 13] Recent guidelines have recommended a number of options for malaria chemoprophylaxis, including chloroquine, doxycycline, melfoquine, and atovaquone plus proguanil, depending on the resistance patterns of the malaria likely to be encountered by the traveler.