Croft A M, Garner P
Surgeon General's, Ministry of Defence, Room 9390, Main Building, Whitehall, London, UK, SW1A 2HB.
Cochrane Database Syst Rev. 2000(3):CD000138. doi: 10.1002/14651858.CD000138.
Mefloquine is a commonly prescribed antimalarial drug which has now largely replaced earlier malaria chemoprophylaxis, since increasing parasite resistance has meant that these earlier drugs are no longer considered to be effective against all Plasmodium species. However mefloquine may be associated with neuropsychiatric harmful effects.
The objective of this review was to assess the effects of mefloquine in adult travellers.
We searched the Cochrane Infectious Diseases Group trials register, MEDLINE, EMBASE, Lilacs, Science Citation Index and reference lists of articles. We contacted researchers in the subject of malaria chemoprophylaxis, and drug companies.
Randomised trials comparing mefloquine with other standard prophylaxis or placebo in non-immune adult travellers, and in non-travelling volunteers. We compiled and included in the review a database of published case reports of mefloquine adverse effects.
We independently assessed trial quality and extracted data. We also contacted study authors.
We included 10 trials involving 2750 non-immune adult participants. Five of these were field trials, and of these all were in soldiers. One trial comparing mefloquine with placebo showed mefloquine prevented malaria episodes in an area of drug resistance (odds ratio 0.04, 95% confidence interval 0.02 to 0.08). Withdrawals in the mefloquine group were consistently higher in four placebo controlled trials (odds ratio 3.56, 95% confidence interval 1.67 to 7.60). In five trials comparing mefloquine with other chemoprophylaxis, no difference in tolerability was detected. We found 519 published case reports of mefloquine adverse effects. 71 per cent of these published reports involved tourists and business travellers.
REVIEWER'S CONCLUSIONS: Mefloquine prevents malaria, but there is not enough evidence to evaluate its tolerability in non-military travellers. There is evidence from non-randomised studies that mefloquine is a potentially harmful drug for tourists and business travellers, needing more careful evaluation. A randomised tolerability study is urgently needed in these groups.
甲氟喹是一种常用的抗疟药物，由于寄生虫耐药性增加，早期的抗疟化学预防药物已不再被认为对所有疟原虫种类都有效，因此甲氟喹现已在很大程度上取代了它们。然而，甲氟喹可能会产生神经精神方面的有害影响。
本综述的目的是评估甲氟喹对成年旅行者的影响。
我们检索了Cochrane传染病小组试验注册库、MEDLINE、EMBASE、Lilacs、科学引文索引以及文章的参考文献列表。我们联系了疟疾化学预防领域的研究人员和制药公司。
在非免疫的成年旅行者以及非旅行志愿者中，比较甲氟喹与其他标准预防措施或安慰剂的随机试验。我们整理并纳入了一份已发表的甲氟喹不良反应病例报告数据库。
我们独立评估试验质量并提取数据。我们还联系了研究作者。
我们纳入了10项试验，涉及2750名非免疫成年参与者。其中5项是现场试验，且所有这些试验的对象都是士兵。一项比较甲氟喹与安慰剂的试验表明，在耐药地区甲氟喹可预防疟疾发作（比值比0.04，95%置信区间0.02至0.08）。在四项安慰剂对照试验中，甲氟喹组的退出率始终较高（比值比3.56，95%置信区间1.67至7.60）。在五项比较甲氟喹与其他化学预防措施的试验中，未检测到耐受性方面的差异。我们发现了519篇已发表的甲氟喹不良反应病例报告。这些已发表报告中71%涉及游客和商务旅行者。
甲氟喹可预防疟疾，但没有足够的证据来评估其在非军事旅行者中的耐受性。非随机研究的证据表明，甲氟喹对游客和商务旅行者可能是一种有害药物，需要更仔细的评估。迫切需要在这些人群中进行随机耐受性研究。
