Quimioprofilaxia da malária com mefloquina na amazônia brasileira

Abstract

In a randomised double-blind study 122 volunteers living in an endemic malarious area in Amazonian Rondônia state were divided into 4 groups to study malaria suppression. . The first group received 500 mg of mefloquine every month, group II 250 mg every two weeks, group III a tablet of Fansidar (500 mg sulphadoxine + 25mg pyrimethamine) a week and group IV placebo. Acute attacks of malaria occurred in one individual in group I, 2 subject in group II, and 6 individuals in groups III and IV. Protection with mefloquine was significant compared with the placebo group. Both treatment regimens with mefloquine were effective suppressants in an area of high prevalence of drug multiresistant Plasmodium falciparum transmission.

Mefloquine for preventing malaria during travel to endemic areas

“…Efficacy outcomes were reported in 14 RCTs conducted between 1977 and 2003 in Thailand (four trials), Brazil, Cambodia, Ghana, Indonesia, Ivory Coast, Malawi, Nigeria, Kenya and two studies which included travellers to various destinations (10,710 participants). Two were conducted in short‐term international travellers ( Overbosch 2001 ; Schlagenhauf 2003 ); nine involved general populations living in endemic areas who are likely to have some immunity to malaria ( Boudreau 1991 ; Bunnag 1992 ; Hale 2003 ; Nosten 1994 ; Pearlman 1980 ; Salako 1992 ; Sossouhounto 1995 ; Steketee 1996 ; Weiss 1995 ), two recruited non‐immune military personnel ( Arthur 1990 ; Ohrt 1997 ), and one recruited a mixed military and civilian semi‐immune population ( Santos 1993 ).…”

“…Six trials had low and balanced losses to follow‐up rates for efficacy outcomes ( Hale 2003 ; Nosten 1994 ; Overbosch 2001 ; Salako 1992 ; Sossouhounto 1995 ; Weiss 1995 ). One trial was at high risk of bias because investigators did not follow up participants beyond the active phase of treatment for relapses ( Santos 1993 ). Two studies did not make the method of detection of malaria, frequency or duration of follow up clear ( Arthur 1990 ; Schlagenhauf 2003 ).…”

“…Seven trials were sponsored by Roche (manufacturer of mefloquine) ( Bunnag 1992 ; Davis 1996 ; Ohrt 1997 ; Santos 1993 ; Schlagenhauf 1997 ; Schlagenhauf 2003 ; Vuurman 1996 ), three were sponsored by GlaxoSmithKline (manufacturer of atovaquone‐proguanil) ( Hale 2003 ; Overbosch 2001 ; Schlagenhauf 2003 ), one by Pfizer (manufacturer of doxycycline) ( Ohrt 1997 ), and one by Mepha Ltd (manufacturer of a film‐coated form of mefloquine) ( Potasman 2002 ). Only one made the role of the study sponsor clear ( Ohrt 1997 ).…”

“…The participants in four trials from Africa were described as semi‐immune ( Hale 2003 ; Salako 1992 ; Sossouhounto 1995 ; Weiss 1995 ). Santos 1993 was conducted in an area of Brazil in which endemic transmission occurs.…”

“…Babies were assessed at birth and at 2 and 9 months None Various Government funding Ohrt 1997 Indonesian soldiers 204 Two symptom questionnaires. Daily interview with study personnel History of underlying illness 13 weeks Roche, Pfizer, USA Army Pearlman 1980 Thai residents aged 10 to 60 years 990 Weekly sick call by study personnel None 26 weeks Not mentioned Potasman 2002 Israeli adults who did not travel 90 Self‐reporting diary History of depression 48 hours Mepha Ltd Salako 1992 Nigerian adult males 567 Interview with study personnel None 24 weeks Not mentioned Santos 1993 Brazilian civilians and soldiers aged 12 to 55 128 Interview w ith study personnel None 17 weeks Roche Schlagenhauf 1997 Swissair trainee pilots who did not travel 23 Interview with study personnel Psychosis or severe depression 4 weeks Roche Sossouhounto 1995 Ivory C oast adult males 500 …”