MEFLOQUINE TO PREVENT MALARIA - A SYSTEMATIC REVIEW OF TRIALS

Objective: To evaluate the research evidence on the efficacy and toler ability of mefloquine chemoprophylaxis. Search strategy: Any potential ly relevant trial from the Cochrane Infectious Disease Group's registe r of controlled trials; systematic searches of Medline, Embase, Lilacs and Science Citation Index; scanning citations; and consulting drug c ompanies and key investigators. We considered studies in all languages . Inclusion criteria: Trials carried out in non-immune adult traveller s, and in non-travelling volunteers, where an attempt had been made to conduct a randomised comparison of mefloquine against placebo or agai nst alternative standard prophylaxis. Results: 37 potentially eligible trials of mefloquine prophylaxis were identified, and 10 met the incl usion criteria These 10 trials comprised a total of 2750 non-immune ad ult participants randomised to mefloquine or to a control. One placebo controlled trial examined malaria incidence directly and showed meflo quine to be highly effective in preventing malaria in an area of drug resistance. However, four placebo controlled trials showed that mefloq uine was not well tolerated, and withdrawals were consistently higher in mefloquine treatment arms than in placebo arms (odds ratio 3.49 (95 % confidence interval 1.42 to 8.56)). Five field trials compared meflo quine with other chemoprophylaxis. Mefloquine was no worse tolerated t han other chemoprophylaxis, although there was possibly a trend toward s higher withdrawals in mefloquine arms (odds ratio 1.33 (0.75 to 2.36 )). Conclusion: One trial showed mefloquine to be effective in prevent ing malaria, but withdrawal rates, presumably from side effects, were high across most studies. This is likely to impair mefloquine's effect iveness in general travellers, and it may therefore not be useful for routine prophylaxis. Mefloquine may be useful in specific situations s uch as for groups travelling to regions with a high risk of chloroquin e resistant malaria and only limited access to effective medical care.