Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Tepper and colleagues point out that Canadian troops serving in Afghanistan are now offered alternatives to mefloquine for their malaria chemoprophylaxis in theater. Mefloquine has been associated with serious psychiatric events during travel abroad.1 A recent survey of case reports found that mefloquine has also been associated with 19 deaths in users, including 3 suicides.2 It is therefore reasonable to avoid prescribing a drug with potential serious risks (mefloquine) as first-line prophylaxis against an infection (P vivax malaria) that has low regional endemicity, seasonal transmission, and low lethality.
Croft AM, Darbyshire AH, Jackson CJ, van Thiel PP. Malaria Chemoprophylaxis for Coalition Troops in Afghanistan—Reply. JAMA. 2007;298(11):1275-1276. doi:10.1001/jama.298.11.1275-b