Compliance and tolerability of mefloquine and chloroquine plus proguanil for long-term malaria chemoprophylaxis in groups at particular risk (the military)

Abstract

An historical prospective study was performed on 5120 Italian soldiers deployed in Somalia and Mozambique in 1992–1994, to determine compliance and tolerability of long-term malaria chemoprophylaxis with chloroquine plus proguanil (C + P) and with mefloquine. Compliance with C + P among 3734 soldiers on duty in Somalia for 3·8 ± 1·8 months and with mefloquine among 1386 soldiers on duty in Mozambique for 3·4 ± 1·5 months was 90·3% and 95·7%, respectively (P < 0·01). Chemoprophylaxis curtailment rate due to side-effects was 1·5% among C + P users and 0·9% among mefloquine users (P = NS). Compliance with chemoprophylaxis and medication curtailment rate due to side-effects did not change significantly for either C + P or mefloquine, even after 3 months of continuous prophylaxis. Chemoprophylaxis curtailment rate was significantly lower in subjects aged ⩽25 years than in older subjects (1·3% vs. 2·5% for C + P [P < 0·05] and 0·4% vs. 3·3% for mefloquine [P < 0·01]). These results further support the evidence that both C + P and mefloquine regimens may be safely used in long-term malaria chemoprophylaxis. Moreover, weekly mefloquine seems easier to perform than C + P and not to increase prophylaxis discontinuation due to side-effects. Mefloquine regimen should therefore be considered the elective chemoprophylaxis for groups at particular risk of chloroquine-resistant Plasmodium falciparum malaria and especially for young male subjects.

malaria, chemoprophylaxis, chloroquine, proguanil, mefloquine, compliance, tolerability, side-effects, Somalia, Mozambique