US military should ensure careful screening prior to prescribing anti-malarial drug, mefloquine

Malaria is a constant threat to US military personnel operating in Afghanistan, but some troops may face further risk, as epidemiologists have revealed a significant prevalence of contraindications to the safe use of the anti-malarial drug, mefloquine.

Whilst mefloquine has traditionally been considered an effective prevention for long-term malaria chemoprophylaxis, research reported in the open access publication, Malaria Journal, suggests that US military physicians should ensure careful screening processes prior to prescribing and dispensing the drug. Ignoring such contraindications may lead to an increased incidence of psychiatric and neurological disorders.

An epidemiological study from the US Army Center for Health Promotion and Preventive Medicine, led by Remington Nevin, used military medical surveillance and pharmacosurveillance databases to identify contraindications to mefloquine use among a cohort of 11,725 active duty U.S. military personnel, recently deployed to Afghanistan. The study indicates that 9.6 percent of service members deployed to Afghanistan in early 2007 had evidence of psychiatric, medical or pharmacological contraindications to mefloquine, the primary drug used to protect service members from malaria, which is endemic there. It was also reported that females were twice as likely as males to have a contraindication.

This work underscores the importance of proper systematic screening prior to prescribing and dispensing mefloquine, and the need to provide alternatives to mefloquine suitable for long-term administration among deployed U.S. military personnel.

“Mefloquine is generally considered safe when prescribed and dispensed appropriately, and when used as directed. However, this study provides evidence that mefloquine is not a suitable option for a significant number of deploying U.S. servicemembers. This study points to the need for enhanced vigilance during pre-deployment medical screening to ensure the appropriate use of this medication, particularly among females, and underscores the need for continued investment in research and development of alternatives to mefloquine that retain the advantages in compliance of a weekly medication.”