13,14 Quinine, which is only indicated

for the treatment of malaria, would not be prescribed nearly as often as prophylaxis medications, potentially making this mistake easy to perpetuate. Because our study was not designed to specifically Selleckchem ONO-4538 assess the reasons medications were or were not stocked, we cannot confirm whether the decision on quinine is driven by financial pressures or mistaken information. However, our findings have important implications for artemether-lumefantrine, newly FDA approved in the United States, which also has no role in prophylaxis. Physicians should be aware of the potential for limited availability of first-line therapy medications when considering outpatient therapy. Chloroquine was most likely to be stocked in the moderate-risk regions. Whether this represents higher prophylaxis usage rates for travel to chloroquine sensitive P falciparum regions is not known. Of concern, we identified one pharmacy that continues to stock sulfadoxine-pyrimethamine, which is no longer Selleckchem Antiinfection Compound Library a CDC recommended prophylactic or therapeutic medication. In general, there was a notably decreased availability of pediatric formulations, dosage strengths, and compounding across all risk regions. Although this

would not directly impact therapy in most cases, it does reflect an age-based bias in terms of ready access to prophylaxis. This finding is likely affected by the relative frequency that prescriptions for adult versus pediatric formulations are filled. This study is limited by the relatively small number of pharmacies and narrow geographic area sampled. The number of pharmacies in the studied ZIP codes was not known prior to their selection as study sites. These areas were chosen based on unique demographic features, which allowed for stratification of risk based on the ethnic makeup of the resident population, income, and known malaria cases. An unexpectedly high percentage of directory listings

for pharmacies were either redundant or inaccurate. Although we were not able to balance the number of pharmacies across stratification groups, this represents the true life Farnesyltransferase experience of people residing in these areas. The population data utilized in this study is from the 2000 US Census. Given that the Washington, DC metropolitan region has one of the fastest growing populations of sub-Saharan African immigrants,15 repeating this study based on data from the upcoming 2010 US Census may also influence the results. We would suggest that a follow-up study that is larger in scope may offer both a stronger statistical analysis and broader view of the national availability of these medications. This is also important given that the community level availability of artemether-lumefantrine and the nation-wide availability of quinine sulfate are not known.