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Mefloquine for malarial prophylaxis in military personnel

BMJ 2015; 351 doi: (Published 03 November 2015) Cite this as: BMJ 2015;351:h5797
  1. Nithya J Gogtay, professor1,
  2. Robin E Ferner, professor23
  1. 1Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
  2. 2West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
  3. 3School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
  1. Correspondence to: R E Ferner r.e.ferner{at}

Not the first choice

The British Army adopted mefloquine (Lariam) as its preferred drug for chemoprophylaxis against malaria in 1993. Treatment doses of mefloquine had already been reported to cause an acute brain syndrome.1 In 1996, army doctors reported a private soldier who, after six doses of mefloquine prophylaxis, saw the Grim Reaper standing behind the chaplain, heard incoherent voices, and was admitted to a psychiatric hospital2; more reports followed. A health minister explained reassuringly that the increase in reports was “not unexpected.”3 Twenty years later, we are still uncertain how safe mefloquine is, and the media have focused attention on whether the drug should still be used for chemoprophylaxis by British troops, a group with limited autonomy. The UK defence authorities are under renewed pressure to rethink their policy.4

The threat of malaria remains real, with over 1500 imported cases each year in the United Kingdom and several deaths. The key to malaria prophylaxis is to prevent bites by using suitable clothing, bed nets, …

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