Mefloquine to prevent malaria: a systematic review of trials
Mefloquine to prevent malaria: a systematic review of trials
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DOI：
10.1136/bmj.315.7120.1412
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发表时间：
1997-11-29
影响因子：
--
通讯作者：
Garner, P
中科院分区：
文献类型：
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作者：
Croft, A;Garner, P
目的：评估甲氟喹化学预防的有效性和耐受性的研究证据。搜索策略：来自 Cochrane 传染病组对照试验登记册的任何潜在相关试验； Medline、Embase、Lilacs 和 Science Citation Index 的系统检索；扫描引文；并咨询制药公司和主要研究人员。我们考虑了所有语言的研究。纳入标准：在非免疫成年旅行者和非旅行志愿者中进行的试验，试图对甲氟喹与安慰剂或替代标准预防进行随机比较。结果：确定了 37 项潜在合格的甲氟喹预防试验，其中 10 项符合纳入标准。这 10 项试验总共包括 2750 名非免疫成人参与者，随机分组甲氟喹或对照。一项安慰剂对照试验直接检查了疟疾发病率，结果表明甲氟喹在预防耐药区域的疟疾方面非常有效。然而，四项安慰剂对照试验表明，甲氟喹的耐受性不佳，甲氟喹治疗组的戒断率始终高于安慰剂组（比值比 3.49（95% 置信区间 1.42 至 8.56））。五项现场试验将甲氟喹与其他化学预防方法进行了比较。甲氟喹的耐受性并不比其他化学预防药物更差，尽管甲氟喹治疗组可能存在停药率较高的趋势（比值比 1.33（0.75 至 2.36））。结论：一项试验表明甲氟喹可有效预防疟疾，但大多数研究中的停药率（可能是由于副作用）较高。这可能会损害甲氟喹对一般旅行者的有效性，因此可能对常规预防没有用处。甲氟喹在特定情况下可能有用，例如对于前往耐氯喹疟疾高风险地区且获得有效医疗服务机会有限的群体。
Objective: To evaluate the research evidence on the efficacy and tolerability of mefloquine chemoprophylaxis.Search strategy: Any potentially relevant trial from the Cochrane Infectious Disease Group's register of controlled trials; systematic searches of Medline, Embase, Lilacs and Science Citation Index; scanning citations; and consulting drug companies and key investigators. We considered studies in all languages.Inclusion criteria: Trials carried out in non-immune adult travellers, and in non-travelling volunteers, where an attempt had been made to conduct a randomised comparison of mefloquine against placebo or against alternative standard prophylaxis.Results: 37 potentially eligible trials of mefloquine prophylaxis were identified, and 10 met the inclusion criteria These 10 trials comprised a total of 2750 non-immune adult participants randomised to mefloquine or to a control. One placebo controlled trial examined malaria incidence directly and showed mefloquine to be highly effective in preventing malaria in an area of drug resistance. However, four placebo controlled trials showed that mefloquine was not well tolerated, and withdrawals were consistently higher in mefloquine treatment arms than in placebo arms (odds ratio 3.49 (95% confidence interval 1.42 to 8.56)). Five field trials compared mefloquine with other chemoprophylaxis. Mefloquine was no worse tolerated than other chemoprophylaxis, although there was possibly a trend towards higher withdrawals in mefloquine arms (odds ratio 1.33 (0.75 to 2.36)).Conclusion: One trial showed mefloquine to be effective in preventing malaria, but withdrawal rates, presumably from side effects, were high across most studies. This is likely to impair mefloquine's effectiveness in general travellers, and it may therefore not be useful for routine prophylaxis. Mefloquine may be useful in specific situations such as for groups travelling to regions with a high risk of chloroquine resistant malaria and only limited access to effective medical care.