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Comparison of adverse events associated with use of mefloquine and combination of chloroquine and proguanil as antimalarial prophylaxis: postal and telephone survey of travellers

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7056.525 (Published 31 August 1996) Cite this as: BMJ 1996;313:525
  1. P J Barrett, senior medical advisera,
  2. P D Emmins, technical directora,
  3. P D Clarke, medical directora,
  4. D J Bradley, professor of tropical hygieneb
  1. a Medical Advisory Services for Travellers Abroad, London WC1E 7HT,
  2. b London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to:.
  • Accepted 17 June 1996

Abstract

Objective: To compare the frequency of adverse events, particularly neuropsychiatric effects, from mefloquine and from chloroquine plus proguanil as used for malaria chemoprophylaxis.

Design: Retrospective questionnaire to travellers taking either regimen between November 1993 and February 1995; telephone interview with those reporting pronounced side effects.

Setting: Travellers from Britain who consulted an advisory helpline.

Subjects: 1214 adults taking mefloquine and 1181 taking chloroquine plus proguanil.

Main outcome measures: Reported presence of and degree of disability from 12 neuropsychiatric and other symptoms, as assessed by the subjects and by referees and on the basis of behaviour change.

Results: There were equal rates of any side effects (40%) and of stopping or changing medication. Overall, neuropsychiatric adverse events were significantly more common in travellers taking mefloquine. In all, 333 neuropsychiatric adverse events were reported by 1214 travellers taking mefloquine, compared with 189 such events in 1181 travellers taking proguanil plus chloroquine (P<0.001). In all, 0.7% of travellers taking mefloquine had disabling neuropsychiatric adverse effects, compared with 0.09% of those taking proguanil plus chloroquine (P = 0.021). Two travellers taking mefloquine (1 in 607) were admitted to hospital as a result of the adverse event, compared with 1 in 1181 travellers taking proguanil plus chloroquine.

Conclusion: There is a significant excess of adverse neuropsychiatric events of intermediate degrees of severity associated with the use of mefloquine compared with proguanil plus chloroquine. This finding may also explain the discrepant findings between earlier studies and clinical experience.

Key messages

  • This study shows that about 40% of travellers taking either mefloquine or chloroquine and proguanil can expect to experience some sort of adverse side effect, although most side effects will be relatively trivial

  • About 0.7% (1 in 140) travellers taking mefloquine can expect to have a neu-ropsychiatric adverse event unpleasant enough to temporarily prevent them from carrying out their day to day activities, compared with 0.09% (1 in 1100) taking chloroquine and proguanil

  • Mefloquine is appropriate only when the risk is high both of malaria and of chloroquine resistance

Footnotes

  • Funding Grant from Shell International.

  • Conflict of interest None.

  • Accepted 17 June 1996
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