Mefloquine Use and Hospitalizations Among Us Service Members, 2002–2004

Wells, Timothy S.; Smith, Tyler C.; Smith, Besa; Wang, Linda Z.; Hansen, Christian J.; Reed, Robert J.; Goldfinger, Wendy E.; Corbeil, Thomas; Spooner, Christina N.; Ryan, Margaret A. K.

doi:10.4269/ajtmh.2006.74.744

Cited by 23 publications

(24 citation statements)

References 32 publications

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“…5,8,15,17,30 Specifically among U.S. military deployers, Wells and others reported no association between mefloquine prescriptions and hospitalizations for a wide range of outcomes. 5 Additional studies among deployed military populations reported mefloquine to be well tolerated, with the exception of individuals previously diagnosed with an NPO. 15,17,30 Contrary to our findings, other studies have reported an association between NPOs and mefloquine.…”

Section: Discussionmentioning

confidence: 99%

“…4 Serious adverse events after mefloquine use are rare. [5][6][7] Studies evaluating the occurrence of neuropsychiatric outcomes (NPOs) after mefloquine use report mixed results, but a large proportion of these studies found an association between mefloquine and NPOs. [7][8][9][10][11][12][13][14][15][16][17] Due to the extensive use of mefloquine for malaria prevention among service members before 2009 and its continued, limited use, after that point, the need to evaluate adverse events in service members who took the drug is evident.…”

Section: Introductionmentioning

confidence: 99%

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Neuropsychiatric Outcomes After Mefloquine Exposure Among U.S. Military Service Members

Eick-Cost

Rohrbeck

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Mefloquine was widely prescribed to U.S. military service members until 2009 when use was limited to personnel with contraindications to doxycycline and no contraindications to mefloquine. The need to estimate the occurrence of neuropsychiatric outcomes (NPOs) in service members prescribed mefloquine warranted a comprehensive evaluation of this issue. Active component service members filling a prescription for mefloquine, doxycycline, or atovaquone/proguanil (A/P) between January 1, 2008 and June 30, 2013, were included in the analysis. The risk of developing incident NPOs and the risk of subsequent NPOs among subjects with a history of the condition were assessed. A total of 367,840 individuals were evaluated (36,538 received mefloquine, 318,421 received doxycycline, and 12,881 received A/P). Among deployed individuals prescribed mefloquine, an increased risk of incident anxiety was seen when compared with doxycycline recipients (incidence rate ratio [IRR] = 1.12 [1.01-1.24]). Among nondeployed mefloquine recipients, an increased risk of posttraumatic stress disorder (PTSD) was seen when compared with A/P recipients (IRR = 1.83 [1. 07-3.14]). An increased risk of tinnitus was seen for both deployed and nondeployed mefloquine recipients compared with A/P recipients (IRR = 1.81 [1.18-2.79]), 1.51 (1.13-2.03), respectively). Six percent of the mefloquine cohort had an NPO in the year before receiving mefloquine. When comparing individuals with a prior neuropsychiatric history to those without, the ratio of relative risks for adjustment disorder, anxiety, insomnia, and PTSD were higher (not statistically significant) for mefloquine compared with doxycycline. These findings emphasize the continued need for physicians prescribing mefloquine to conduct contraindication screening.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric Outcomes After Mefloquine Exposure Among U.S. Military Service Members

Eick-Cost

Rohrbeck

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…Mefloquine is the best-documented drug for long-term travelers and, if well tolerated, can be used for prolonged periods; i.e., there is no upper time limits for the use of mefloquine (34). It has a simple weekly dosing schedule that encourages adherence (39), and toxic accumulation in the body does not occur during longterm use (14). Doxycycline (a tetracycline compound) is used for This means that long-term travelers must have knowledge about malaria as a disease, including key symptoms such as fever, the adequate use of SBET, the problems of counterfeit drugs, and the need to identify reliable health care facilities in case of emergency.…”

Section: Prophylaxis For Long-term Visitors and Frequent Visitorsmentioning

confidence: 99%

Malaria Chemoprophylaxis: Strategies for Risk Groups

Schlagenhauf

Petersen

2008

Clin Microbiol Rev

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SUMMARY The risk of malaria for travelers varies from region to region and depends on the intensity of transmission, the duration of the stay in the area of endemicity, the style of travel, and the efficacy of preventive measures. The decision to recommend chemoprophylaxis to travelers to areas with a low risk of malarial infection is especially difficult because the risk of infection must be balanced with the risk of experiencing side effects. If the risk of side effects by far exceeds the risk of infection, the traveler needs information on measures against mosquito bites and advice on prompt diagnosis and self-treatment. The risk is difficult to quantify, and the absolute risk for travelers to most areas is not known, especially because the populations at risk are unknown. We propose here that the best approximation of the risk to the traveler to a specific area is to use the risk to the indigenous population as a guideline for the risk to the traveler, and we provide examples on how risk in the indigenous population can be used for the estimation of risk of malarial infection for travelers. Special groups are long-term visitors and residents, who often perceive risk differently, cease using chemoprophylaxis, and rely on self-diagnosis and treatment. For long-term visitors, the problem of fake drugs needs to be discussed. Strategies for chemoprophylaxis and self-treatment of pregnant women and small children are discussed. So far, malaria prophylaxis is recommended to prevent Plasmodium falciparum infections, and primaquine prophylaxis against persistent Plasmodium vivax and Plasmodium ovale infections in travelers is not recommended.

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“…57 In contrast, mefloquine use among US service members from 2002-2004 was not associated with severe health effects. 58 Mefloquine was well tolerated when used for more than 3 months in Italian soldiers in Somalia and Mozambique 59 as well as in Peace Corps Volunteers, where it was used for up to 2.5 years. 48 Only 0.3% of Dutch marines who used mefloquine for 6 months reported adverse effects requiring medical attention.…”

Section: Safety Of Malaria Chemoprophylaxis For Long-term Travelmentioning

confidence: 99%