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(4):CD000138. doi: 10.1002/14651858.CD000138.
Mefloquine is commonly prescribed to prevent malaria in travellers, and has replaced other drugs because Plasmodium falciparum is commonly resistant to them. However, mefloquine may be associated with neuropsychiatric harmful effects.
To assess the effects of mefloquine in adult travellers compared to other regimens in relation to episodes of malaria, withdrawal from prophylaxis, and adverse events.
We searched the Cochrane Infectious Diseases Group trials register, MEDLINE, EMBASE, LILACS, Science Citation Index and bibliographies in retrieved papers and standard textbooks. 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. For adverse events, any published case reports were collected.
We independently assessed trial quality and extracted data. Adverse events from observational studies were categorised by the study type. 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 mainly male 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 516 published case reports of mefloquine adverse effects. 63 per cent of these published reports involved tourists and business travellers. There were four fatalities attributed to mefloquine.
REVIEWER'S CONCLUSIONS: Mefloquine prevents malaria, but has adverse effects that limit its acceptability. There is evidence from non-randomised studies that mefloquine has potentially harmful effects in tourists and business travellers, and its use needs to be carefully balanced against this. Trials of comparative effects of antimalarial prophylaxis should include episodes of malaria and withdrawal from prophylaxis as outcomes.
甲氟喹常用于预防旅行者疟疾，且由于恶性疟原虫对其他药物普遍耐药，甲氟喹已取代了这些药物。然而，甲氟喹可能会产生神经精神方面的有害影响。
与其他预防方案相比，评估甲氟喹对成年旅行者疟疾发作、停止预防用药及不良事件的影响。
我们检索了Cochrane传染病组试验注册库、MEDLINE、EMBASE、拉丁美洲及加勒比卫生科学数据库、科学引文索引以及检索到的论文和标准教科书中的参考文献。我们联系了疟疾化学预防领域的研究人员以及制药公司。
在非免疫成年旅行者和非旅行志愿者中，比较甲氟喹与其他标准预防措施或安慰剂的随机试验。对于不良事件，收集所有已发表的病例报告。
我们独立评估试验质量并提取数据。观察性研究中的不良事件按研究类型进行分类。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项为现场试验，且这些试验的参与者主要是男性士兵。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，甲氟喹组的停药率始终较高（比值比为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516篇关于甲氟喹不良反应的已发表病例报告。这些已发表报告中有63%涉及游客和商务旅行者。有4例死亡归因于甲氟喹。
甲氟喹可预防疟疾，但存在不良影响，这限制了其可接受性。非随机研究有证据表明，甲氟喹对游客和商务旅行者有潜在有害影响，其使用需要在此基础上仔细权衡。抗疟预防措施比较效果的试验应将疟疾发作和停止预防用药作为观察指标。
