Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Ministry of Defence:
To ask Her Majesty's Government whether Lariam is restricted in its use by military personnel only to those who are unable to tolerate available alternatives.
Answered by Earl Howe - Deputy Leader of the House of Lords
In June 2017, the Government updated its policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1). The leaflet includes guidance on antimalarial drug use, requiring that drugs only be supplied after a face-to-face malaria health risk assessment, following the Defence Medical Information Capability Programme antimalarial protocol.
The recommended drug regime is determined by the sensitivity of malaria parasites to antimalarial drugs in different parts of the world, based on Public Health England guidance. For areas without drug resistance the recommendation is that individuals are offered chloroquine on its own. If chloroquine is not suitable then proguanil is the preferred alternative. For areas of little chloroquine resistance, it is recommended that individuals are offered both chloroquine and proguanil. If chloroquine and proguanil are not suitable and the patient can tolerate proguanil then the patient should normally be offered atovaquone and proguanil.
For areas where malarial parasites are known to be resistant to chloroquine it is recommended that individuals are offered atovaquone and proguanil. If atovaquone and proguanil is not suitable they are to be reviewed in order to determine which alternative drug is most appropriate. The second choice drug will normally be doxycycline but may be modified in accordance with the disease profile of the country to be visited. If doxycycline is unsuitable then mefloquine may be prescribed but only after the individual has been reviewed by a doctor.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Ministry of Defence:
To ask Her Majesty's Government whether they have developed guidelines about the use of Lariam and other antimalarial drugs, specific to their use by military personnel.
Answered by Earl Howe - Deputy Leader of the House of Lords
In June 2017, the Government updated its policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1). The leaflet includes guidance on antimalarial drug use, requiring that drugs only be supplied after a face-to-face malaria health risk assessment, following the Defence Medical Information Capability Programme antimalarial protocol.
The recommended drug regime is determined by the sensitivity of malaria parasites to antimalarial drugs in different parts of the world, based on Public Health England guidance. For areas without drug resistance the recommendation is that individuals are offered chloroquine on its own. If chloroquine is not suitable then proguanil is the preferred alternative. For areas of little chloroquine resistance, it is recommended that individuals are offered both chloroquine and proguanil. If chloroquine and proguanil are not suitable and the patient can tolerate proguanil then the patient should normally be offered atovaquone and proguanil.
For areas where malarial parasites are known to be resistant to chloroquine it is recommended that individuals are offered atovaquone and proguanil. If atovaquone and proguanil is not suitable they are to be reviewed in order to determine which alternative drug is most appropriate. The second choice drug will normally be doxycycline but may be modified in accordance with the disease profile of the country to be visited. If doxycycline is unsuitable then mefloquine may be prescribed but only after the individual has been reviewed by a doctor.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Ministry of Defence:
To ask Her Majesty's Government in what circumstances it is considered suitable to prescribe the antimalarial drug mefloquine to members of the Armed Forces.
Answered by Earl Howe - Deputy Leader of the House of Lords
In June 2017, the Government updated its policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1). The leaflet includes guidance on antimalarial drug use, requiring that drugs only be supplied after a face-to-face malaria health risk assessment, following the Defence Medical Information Capability Programme antimalarial protocol.
The recommended drug regime is determined by the sensitivity of malaria parasites to antimalarial drugs in different parts of the world, based on Public Health England guidance. For areas without drug resistance the recommendation is that individuals are offered chloroquine on its own. If chloroquine is not suitable then proguanil is the preferred alternative. For areas of little chloroquine resistance, it is recommended that individuals are offered both chloroquine and proguanil. If chloroquine and proguanil are not suitable and the patient can tolerate proguanil then the patient should normally be offered atovaquone and proguanil.
For areas where malarial parasites are known to be resistant to chloroquine it is recommended that individuals are offered atovaquone and proguanil. If atovaquone and proguanil is not suitable they are to be reviewed in order to determine which alternative drug is most appropriate. The second choice drug will normally be doxycycline but may be modified in accordance with the disease profile of the country to be visited. If doxycycline is unsuitable then mefloquine may be prescribed but only after the individual has been reviewed by a doctor.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Ministry of Defence:
To ask Her Majesty's Government, in the light of their response to the report by the House of Commons Defence Select Committee, The use of Lariam for military personnel (4th Report, Session 2015–16), whether, if Lariam is to be supplied to a member of the Armed Forces, the prescribing doctor always actively checks a box to confirm that alternative drugs have been offered to that individual; and if not, when they expect to achieve 100 per cent compliance with that target.
Answered by Earl Howe - Deputy Leader of the House of Lords
The Government's updated policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1) makes it explicit that, if dispensed from a military source, all antimalarial drugs can only be prescribed after a face-to-face assessment with an appropriately trained and regulated healthcare professional has taken place.
The Official Statistic of 16 November 2017, Mefloquine Prescribing in the Armed Forces, shows that between 1 April and 30 September 2017, there were 40 prescriptions for mefloquine out of a total of 6,221 antimalarial prescriptions. Of those 40 prescriptions, 32 had an electronic coded entry on Defence Medical Information Capability Programme for a face-to-face assessment. However, this does not necessarily mean that 8 individuals did not have a face-to-face assessment. If the healthcare professional recorded it as free text rather than using a coded checkbox then it will not appear in the dataset. Of the 40 prescriptions, 28 had an electronic coded entry recording that an alternative antimalarial to mefloquine had been offered. Again, this does not necessarily mean that 12 individuals did not have an alternative offered, for the reasons previously stated.
Given healthcare professionals are permitted to record any part of a consultation in free text, it might be that a face-to-face assessment, or record of alternative antimalarials being offered, will not be recorded through an electronic coded entry in 100 per cent of cases.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Ministry of Defence:
To ask Her Majesty's Government, in the light of their response to the report by the House of Commons Defence Select Committee, The use of Lariam for military personnel (4th Report, Session 2015–16), whether they have now ensured that “all anti-malaria drugs are only supplied after a face-to-face travel health risk assessment performed by an appropriately trained and regulated healthcare professional”; and if not, when they expect to achieve 100 per cent compliance with that target.
Answered by Earl Howe - Deputy Leader of the House of Lords
The Government's updated policy on Preventing Malaria in UK Armed Forces Personnel (Joint Service Publication 950, Part 1, Leaflet 3-3-1) makes it explicit that, if dispensed from a military source, all antimalarial drugs can only be prescribed after a face-to-face assessment with an appropriately trained and regulated healthcare professional has taken place.
The Official Statistic of 16 November 2017, Mefloquine Prescribing in the Armed Forces, shows that between 1 April and 30 September 2017, there were 40 prescriptions for mefloquine out of a total of 6,221 antimalarial prescriptions. Of those 40 prescriptions, 32 had an electronic coded entry on Defence Medical Information Capability Programme for a face-to-face assessment. However, this does not necessarily mean that 8 individuals did not have a face-to-face assessment. If the healthcare professional recorded it as free text rather than using a coded checkbox then it will not appear in the dataset. Of the 40 prescriptions, 28 had an electronic coded entry recording that an alternative antimalarial to mefloquine had been offered. Again, this does not necessarily mean that 12 individuals did not have an alternative offered, for the reasons previously stated.
Given healthcare professionals are permitted to record any part of a consultation in free text, it might be that a face-to-face assessment, or record of alternative antimalarials being offered, will not be recorded through an electronic coded entry in 100 per cent of cases.