Mefloquine for preventing malaria during travel to endemic areas

Background

Mefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travellers to malaria-endemic areas.

Despite its high efficacy, there is controversy about its psychological side effects.

Objectives

To summarize the efficacy and safety of mefloquine used as prophylaxis for malaria in travellers.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials

(CENTRAL), published on the Cochrane Library; MEDLINE; Embase (OVID); TOXLINE (https://toxnet.nlm.nih.gov/newtoxnet/

toxline.htm); and LILACS. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform

(ICTRP; http://www.who.int/ictrp/en/) and ClinicalTrials.gov (https://clinicaltrials.gov/ct2/home) for trials in progress, using ’mefloquine’, ’Lariam’, and ’malaria’ as search terms. The search date was 22 June 2017.

Selection criteria

We included randomized controlled trials (for efficacy and safety) and non-randomized cohort studies (for safety). We compared prophylactic mefloquine with placebo, no treatment, or an alternative recommended antimalarial agent. Our study populations included all adults and children, including pregnant women.

Data collection and analysis

Two review authors independently assessed the eligibility and risk of bias of trials, extracted and analysed data. We compared dichotomous

outcomes using risk ratios (RR) with 95% confidence intervals (CI). Pre specified adverse outcomes are included in ’Summary of findings’ tables, with the best available estimate of the absolute frequency of each outcome in short-term international travellers. We assessed the certainty of the evidence using the GRADE approach.