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Malaria, Mefloquine, Madness, and Mosquito Nets-Reply

Hans O. Lobel, MD, MPH; Eve M. Lackritz, MD; Carlos C. Campbell, MD, MPH
JAMA. 1991;265(21):2808-2809. doi:10.1001/jama.1991.03460210054020.
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In Reply. —  Choosing a drug for prophylaxis against malaria requires weighing the risk of malaria infection against the effectiveness and tolerance of the drug. Mefloquine is the most effective drug available to prevent infections with chloroquine-resistant Plasmodium falciparum malaria, a potentially fatal infection. Available data indicate that the drug is well tolerated when used for prophylaxis at doses of 250 mg. The frequency and type of mild or moderate adverse events reported by users of mefloquine for prophylaxis do not differ from those reported by users of chloroquine for prophylaxis.1,2 Anecdotal case reports suggest that serious neurological and psychiatric events, such as convulsions or hallucinations, are possible with mefloquine for prophylaxis; however, such events have not been reported from prophylactic drug trials or from surveys of users of mefloquine for prophylaxis.1-4 These studies included a total of 18 591 persons.2In contrast, therapeutic doses of mefloquine,

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