Mefloquine versus proguanil in short-term malaria chemoprophylaxis in sickle cell anaemia

Objective: To compare the efficacy and tolerability of mefloquine and progu anil in malaria prophylaxis in sickle cell anaemia. Design: Nonblind, prospective, multicentre study. Participants: The study population consisted of adults and children (aged g reater than or equal to5 years) attending the sickle cell clinics in three centres in Nigeria. Methods: Participants were treated with either a weekly dose of mefloquine (125 or 250mg) or a daily dose of proguanil (100 or 200mg) for 6 months. Co mplete physical examination and parasitology were performed for each patien t at baseline and during and at the end of therapy. Efficacy was evaluated by the absence of parasitaemia during the course of the study; tolerability was evaluated by the incidence of adverse events. Laboratory safety parame ters such as blood count, ALT and serum bilirubin were also monitored. Results: The mean age of the 113 individuals enrolled into the study was 16 .1 +/- 8.3 years. The success rate was 89.2% with mefloquine and 81.8% with proguanil. The incidence of adverse events was 19.6% with mefloquine and 3 1.5% with proguanil. The difference in the efficacy and tolerability profil e between the two treatment groups was not statistically significant (p > 0 .05). None of the patients receiving mefloquine experienced a severe reacti on, and of particular note was the very low incidence of CNS effects such a s dizziness (1.8%) and headache (1.8%). Conclusions: Malaria chemoprophylaxis with a weekly dose of mefloquine in N igerians with sickle cell anaemia appears to be as effective as a daily reg imen with proguanil. The tolerability profile of mefloquine in this group o f patients appears promising.