A Cochrane review «Mefloquine for preventing malaria during travel to endemic areas»1 «Tickell-Painter M, Maayan N, Saunders R et al. Mefloquine for preventing malaria during travel to endemic areas. Cochrane Database Syst Rev 2017;(10):CD006491. »1 included 20 RCTs (11 470 participants); 35 cohort studies (198 493 participants); and four large retrospective analyses of health records (800 652 participants). The efficacy and safety of mefloquine were compared with atovaquone-proguanil and doxycycline.
The absolute risk of malaria during short-term travel was low with all three established antimalarial agents (mefloquine, doxycycline, and atovaquone-proguanil). Mefloquine was associated with more frequent neuropsychiatric adverse events than the two other drugs including abnormal dreams, anxiety, insomnia, and depressed mood.
Clinical comment: The choice of antimalarial agent depends on how individual travellers assess the importance of specific adverse effects, pill burden, and cost. Some travellers will prefer mefloquine for its once-weekly regimen, but this should be balanced against the increased frequency of neuropsychiatric side effects.
Abstract and full text in Cochrane database «https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006491.pub4/full»1 (licence for full text required)
Abstract in McMaster database «Duodecim McMaster Plus References»McMaster (licence required)