Malaria, Mefloquine, Madness, and Mosquito Nets

To the Editor.—  Lobel et al¹ point out that mefloquine is the most effective drug for malaria prophylaxis in sub-Saharan Africa, South America, Asia (except the Middle East), and Oceania. As well, mefloquine is recommended by the Centers for Disease Control as the drug of choice for malaria prophylaxis in these regions.² We would like to caution against indiscriminate use of this drug.Although we agree that travelers at high risk of developing malaria should receive mefloquine, it is not necessarily the drug of choice for all persons traveling to the aforementioned areas because of its neuropsychiatric side effects.³ These may be viewed as minor in the case of inpatient treatment but could prove more important for self-medicated patients in a foreign country, where psychiatric symptoms may not be recognized as such because of language or cultural differences, or may not be properly treated.In our opinion,