Letters Mefloquine in military personnel

Value of mefloquine chemoprophylaxis in military personnel

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6584 (Published 09 December 2015) Cite this as: BMJ 2015;351:h6584
  1. Andrew D Green, defence consultant adviser in communicable diseases1,
  2. Timothy J Hodgetts, medical director1,
  3. David A Ross, defence consultant adviser in public health1,
  4. Patrick Connor, defence consultant adviser in medicine1
  1. 1Defence Medical Services, Royal Centre for Defence Medicine, Birmingham B15 2SQ, UK
  1. andy.green735{at}mod.uk

Gogtay and Ferner raise important issues regarding the use of mefloquine for malaria chemoprophylaxis in British military personnel.1 However, we feel that some points need clarification.

Although malaria has had a major impact on British Armed Forces in the past, the last operational death of a British service person from malaria occurred in 1992. It is a testament to the efficacy of malaria prevention policies since then that no further deaths have occurred despite large numbers of personnel deployed to areas with high rates of malaria transmission, including west Africa. By contrast, France still has on average one death every two years.2

Mefloquine is not the automatic first choice for chemoprophylaxis according to UK Armed Forces current policy.3 Service policy follows national best practice and is based on regularly updated guidance issued by the UK Advisory Committee on Malaria Prevention.4 The drug is one of the available options, and the choice will follow a detailed assessment of the malaria risk related to travel balanced against individual factors. For example, in recently published data, mefloquine was taken by only 0.4% of personnel deployed to Afghanistan between 2007 and 2014 who required chemoprophylaxis, and by 5.7% of personnel deployed to Sierra Leone in 2014.5

Removing a licensed and effective drug from the options available to deployed military personnel would probably reduce the risk of rare and severe adverse effects. An unintended consequence may be an increase in the incidence of malaria and deaths from an infectious disease that is largely preventable.


Cite this as: BMJ 2015;351:h6584



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