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Background: Each year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP's efficacy and tolerance were evaluated in several trials, its use in "real life" conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas., Methods: Between September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up., Results: A total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8% were infected in West Africa, whereas 0.5% were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9% of the patients, the remainder (32.1%) were backpackers. Three-hundred and sixty-four patients (66%) fulfilled follow-up at day 7 and 265 (48%) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77%) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95% [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR., Conclusion: This study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.

Introduction: Multidrug-resistant tuberculosis (MDR-TB) management is based on specific WHO guidelines., Objectives: The authors report MDR-TB management, in three French hospitals., Method: The authors retrospectively included patients with positive sample for multidrug-resistant Mycobacterium tuberculosis (isoniazid+rifampicin) from January 1, 2000 to December 31, 2005. The management was compared to the French and international prevalent guidelines., Results: Sixteen patients were initially managed for MDR-TB by eight different medical teams over 6 successive years: 12 (75%) presented with primary MDR-TB. Management advice from the national referee center (NRC) for tuberculosis was reported in seven out of 14 treated cases. The median length of the intensive treatment was 2 months (IQR: 1-3). Eight patients (58%) had an overall treatment length of 18 months. The median number of effective drugs prescribed was 4 (IQR: 4-5). Nine patients (64%) were also managed in a sanatorium. Only eight patients (57%) completed the prescribed treatment. Nine patients were clinically cured and still followed-up, six of whom were bacteriologically cured., Conclusion: TB-MDR management was not conform to WHO guidelines in our study. Management in a sanatorium, NRC involvement, ambulatory DOT were highly beneficial., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)