University of Zürich Centre for Travel Medicine, Hirschengraben 84, University of Zürich, Switzerland.
Malar J. 2010 Dec 9;9:357. doi: 10.1186/1475-2875-9-357.
Malaria chemoprophylaxis prevents the occurrence of the symptoms of malaria. Travellers to high-risk Plasmodium falciparum endemic areas need an effective chemoprophylaxis.
A literature search to update the status of mefloquine as a malaria chemoprophylaxis.
Except for clearly defined regions with multi-drug resistance, mefloquine is effective against the blood stages of all human malaria species, including the recently recognized fifth species, Plasmodium knowlesi. New data were found in the literature on the tolerability of mefloquine and the use of this medication by groups at high risk of malaria.
Use of mefloquine for pregnant women in the second and third trimester is sanctioned by the WHO and some authorities (CDC) allow the use of mefloquine even in the first trimester. Inadvertent pregnancy while using mefloquine is not considered grounds for pregnancy termination. Mefloquine chemoprophylaxis is allowed during breast-feeding. Studies show that mefloquine is a good option for other high-risk groups, such as long-term travellers, VFR travellers and families with small children. Despite a negative media perception, large pharmaco-epidemiological studies have shown that serious adverse events are rare. A recent US evaluation of serious events (hospitalization data) found no association between mefloquine prescriptions and serious adverse events across a wide range of outcomes including mental disorders and diseases of the nervous system. As part of an in-depth analysis of mefloquine tolerability, a potential trend for increased propensity for neuropsychiatric adverse events in women was identified in a number of published clinical studies. This trend is corroborated by several cohort studies that identified female sex and low body weight as risk factors.
The choice of anti-malarial drug should be an evidence-based decision that considers the profile of the individual traveller and the risk of malaria. Mefloquine is an important, first-line anti-malarial drug but it is crucial for prescribers to screen medical histories and inform mefloquine users of potential adverse events. Careful prescribing and observance of contraindications are essential. For some indications, there is currently no replacement for mefloquine available or in the pipeline.
疟疾化学预防可预防疟疾症状的发生。前往恶性疟原虫流行地区高危地区的旅行者需要有效的化学预防。
检索文献以更新甲氟喹作为疟疾化学预防的现状。
除明确界定的多药耐药区域外，甲氟喹对所有人类疟原虫血期均有效，包括最近确认的第五种疟原虫，即疟原虫 knowlesi。文献中发现了关于甲氟喹耐受性和高危人群使用该药的新数据。
世界卫生组织和一些当局（CDC）允许在妊娠第二和第三期使用甲氟喹，甚至允许在妊娠第一期使用。在使用甲氟喹期间意外怀孕不被视为终止妊娠的理由。甲氟喹化学预防可在哺乳期使用。研究表明，甲氟喹是其他高危人群的不错选择，例如长期旅行者、VFR 旅行者和有小孩的家庭。尽管媒体对此有负面看法，但大型药物流行病学研究表明，严重不良事件很少见。最近美国对严重事件（住院数据）的评估发现，在包括精神障碍和神经系统疾病在内的广泛结局中，甲氟喹处方与严重不良事件之间没有关联。作为对甲氟喹耐受性深入分析的一部分，在许多已发表的临床研究中发现，女性发生神经精神不良事件的倾向存在潜在趋势。一些队列研究证实了这一趋势，这些研究确定了女性性别和低体重是危险因素。
抗疟药物的选择应基于个体旅行者的特征和疟疾风险的循证决策。甲氟喹是一种重要的一线抗疟药物，但开处方者必须筛选病史并告知甲氟喹使用者潜在的不良事件。仔细开处方和遵守禁忌症至关重要。对于某些适应症，目前尚无可用或正在研发的甲氟喹替代品。
