Comments(3)

Why is the US Army using mefloquine prophylaxis in Afghanistan?

Mark Rowland   (24 February 2008)  London School of Hygiene and Tropical Medicine

With such a high rate of adverse reactions to mefloquine propylaxis it makes little sense to continue with this policy in Afghanistan. Malaria in Afghanistan is predominantly caused by vivax (>85%) with 15% at most caused by falciparum (based on trends of reporting based on microscopy at clinics run by reputable NGOs). Of all febrile illness recorded at clinics and diagnosed by blood film only 25% is malaria. This means that falciparum malaria represents less than 5% of all febrile illness. Falciparum is also highly seasonal, occurring during the months of July to October, and occurs only in lowland non-arid areas. If prophylaxis is to be prescribed at all it makes more sense to use chloroquine to which vivax is still susceptible. To continue with a blanket policy of mefloquine prophylaxis when the majority of soldiers will never be based in malaria endemic areas or at times of the year when falciparum is not transmitted, makes little sense when the risks are balanced against the frequency of adverse reactions to mefloquine and the effect these may have on soldier performance under operational conditions.

Competing interests

None.

Mark Rowland managed a malaria control programme in Afghanistan from 1991 until 1999 and still runs malaria research projects in the country.

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US Army Modifies Policy on Mefloquine Prophylaxis in Afghanistan

Remington Nevin   (09 May 2009)  US Army

One year following the publication of this study, the US Army modified its official policy on mefloquine prophylaxis to read as follows:

"In areas where doxycycline and mefloquine are equally efficacious in preventing malaria, doxycycline is the drug of choice. Mefloquine should only be used for personnel with contraindications to doxycycline and [who] do not have any contraindications to the use of mefloquine... Mefloquine should not be given to Soldiers with [a] recent history of Traumatic Brain Injury (TBI) or [who] have symptomatic TBI." [1]

A recent study by Sonmez et al [2] demonstrated that mefloquine and doxycycline are equally efficacious in preventing malaria among military personnel in Afghanistan; in light of this new policy guidance these findings suggest doxycycline should now be considered the drug of choice for US Army service members stationed there.

The study of contraindications to mefloquine use was made possible through a one-time merge of pharmacy data from the Pharmacy Data Transaction Service (PDTS) with data obtained from the Defense Medical Surveillance System (DMSS). Formal integration of PDTS data into DMSS would permit more routine analyses of this type and permit improved monitoring of mefloquine prescribing trends.

Competing interests

None.

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US Army Modifies Policy on Mefloquine Prophylaxis in Afghanistan

Remington Nevin   (11 May 2009)  US Army

The references for the previous comment (US Army Modifies Policy on Mefloquine Prophylaxis in Afghanistan, 09 May 2009) were inadvertently truncated, and appear below:

[1] Department of the Army Office of the Surgeon General Memorandum. Subject: Updated Guidance on the Use of Mefloquine Hydrochloride (Lariam®) for Malaria Prophylaxis. February 2, 2009. Available at http://www.pdhealth.mil/downloads/DASG_Memorandum.pdf

[2] Sonmez A, Harlak A, Kilic S, Polat Z, Hayat L, Keskin O, Dogru T, Yilmaz MI, Acikel CH, Kocar IH. The efficacy and tolerability of doxycycline and mefloquine in malaria prophylaxis of the ISAF troops in Afghanistan. J Infect. 2005;51:253-8.

Competing interests

None.

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