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Mefloquine for preventing malaria in non-immune adult travellers
1Headquarters Defence Secondary Care Agency, Ministry of Defence, Room 570, St Giles' Court, 1-13 St Giles' High Street, London, UK, WC2H 8LD.
Objectives:
Mefloquine has now largely replaced earlier malaria prophylaxis drugs which are no longer considered to be effective against all Plasmodium species, due to parasite resistance. However mefloquine may be associated with neuropsychological harmful effects. The objective of this review was to assess the effects of mefloquine in adult travellers.
Search Strategy:
We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase, Lilacs, Science Citation Index and reference lists of articles. We contacted researchers in the subject of malaria chemoprophylaxis, and drug companies.
Selection Criteria:
Randomised trials comparing mefloquine with other standard prophylaxis or placebo in non-immune adult travellers.
Data Collection And Analysis:
The two reviewers independently assessed trial quality and extracted data. Study authors were also contacted.
Main Results:
Ten trials involving 2750 non-immune adult travellers were included. One trial comparing mefloquine with placebo showed mefloquine prevented malaria episodes in an area of drug resistance (odds ratio 0.04, 95% confidence interval 0.02 to 0.08). Withdrawals in the mefloquine group were consistently higher in four placebo controlled trials (odds ratio 3. 56, 95% confidence interval 1.67 to 7.60). In five trials comparing mefloquine with other chemoprophylaxis, no difference in tolerability was detected.
Reviewer'S Conclusions:
Mefloquine prevents malaria, but there is not enough evidence to evaluate its tolerability and toxicity, particularly for general travellers.