Mefloquine for preventing malaria during travel to endemic areas
Tickell-Painter M1, Maayan N2, Saunders R1, Pace C1, Sinclair D1
1. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
2. Cochrane, Cochrane Response, London, UK
, , , , . . , Issue . Art. No.: CD006491. DOI: 10.1002/14651858.CD006491.pub4
Access the full-text open access article here: DOI/10.1002/14651858.CD006491.pub4/full
Can mefloquine prevent malaria during travel to areas where the disease is widespread?
We summarized trials that evaluated the effectiveness and safety of mefloquine when used to prevent malaria in people travelling to areas where the disease is widespread. We searched for relevant studies up to 22 June 2017 and included 20 randomized trials that involved 11,470 participants, 35 cohort studies (198,493 participants) and four large retrospective analyses of health records (800,652 participants).
What are the concerns about mefloquine and what are the alternatives?
Mefloquine is often prescribed to prevent malaria during travel to areas where the disease is widespread. However, there is controversy about the safety of mefloquine, especially when prescribed for military personnel in stressful situations, and there have been reports of depression and suicide.
The only commonly-used alternative drugs are doxycycline (which can cause skin problems and indigestion) and atovaquone-proguanil (which is often more expensive).
What the research says
Mefloquine appears to be a highly effective drug to reduce the risk of malaria (low-certainty evidence), however, evidence did not come from short-term international travellers.
Mefloquine has not been shown to have more frequent serious side effects than either atovaquone-proguanil (low-certainty evidence) or doxycycline (very low-certainty evidence).
People who take mefloquine are more likely to stop taking the drug due to side effects than people who take atovaquone-proguanil (high-certainty evidence), but may be equally as likely to stop as people who take doxycyline (low-certainty evidence).
People taking mefloquine are more likely to have abnormal dreams, insomnia, anxiety and depressed mood during travel than people who take atovaquone-proguanil (moderate-certainty evidence) or doxycyline (very low-certainty evidence). Doxycycline users are more likely to have dyspepsia, photosensitivity, vomiting, and vaginal thrush (very low-certainty evidence).