Effectiveness and Tolerance of Long-term Malaria Prophylaxis With Mefloquine: Need for a Better Dosing Regimen

Effectiveness and Tolerance of Long-term Malaria Prophylaxis With Mefloquine: Need for a Better Dosing Regimen

To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphat...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association Vol. 265; no. 3; pp. 361 - 364
Main Authors: Lobel, Hans O, Bernard, Kenneth W, Williams, Sharyon L, Hightower, Allen W, Patchen, Leslie C, Campbell, Carlos C
Format: Journal Article
Language:English
Published: United States American Medical Association 16-01-1991
Subjects:
Adult
Africa, Western
Animals
Drug Administration Schedule
Drugs
Humans
International Cooperation
Malaria
Malaria - prevention & control
Medical research
Mefloquine - administration & dosage
Mefloquine - adverse effects
Mefloquine - blood
Mefloquine - therapeutic use
Patient Compliance
Plasmodium falciparum
Volunteers
Africa, Western
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Summary:To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphate weekly. Mefloquine was only 63% more effective than chloroquine; the monthly incidence of P falciparum infections was one case per 100 volunteers who took mefloquine and 2.7 cases per 100 volunteers who took chloroquine. Using daily proguanil (chloroguanide) hydrochloride in addition to chloroquine did not provide additional protection. All mefloquine prophylaxis failures occurred during the second week of the every-2-weeks dosing regimen in volunteers who had used mefloquine for more than 2 months. Blood concentrations of mefloquine were lower during the second week of the alternate-week regimen than during the first week, suggesting that blood levels are too low during the second week to suppress parasitemia. No serious adverse reactions were observed. The results indicate that a dosing regimen of 250 mg of mefloquine weekly should be considered for travelers to areas with chloroquine-resistant P falciparum malaria.(JAMA. 1991;265:361-364)
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.1991.03460030067030