MONDAY, Oct. 12 (HealthDay News) -- Atovaquone-proguanil and doxycycline appear to be relatively well-tolerated for malaria prophylaxis in travelers, and are less likely to cause neuropsychiatric effects than mefloquine, according to research published online Oct. 7 in the Cochrane Database of Systematic Reviews.

Frederique A. Jacquerioz, M.D., of the Tulane School of Public Health and Tropical Medicine in New Orleans, and Ashley M. Croft, M.D., of the Surgeon General's Department in London, reviewed eight trials including 4,240 participants to compare the effects of currently used prophylactic anti-malaria drugs in adult and child travelers going to regions with Plasmodium falciparum resistance to chloroquine.

The researchers found that the results provided little insight into which anti-malaria drug was most effective in preventing malaria. However, mefloquine was associated with more adverse and serious adverse effects than the other anti-malaria approaches. Patients administered atovaquone-proguanil had a lower risk of reporting gastrointestinal and neuropsychiatric adverse effects, as well as any adverse effect compared to mefloquine. In addition, doxycycline was associated with fewer neuropsychiatric events than mefloquine. The combination of chloroquine-proguanil was associated with increased gastrointestinal and any adverse effect as compared to the other approaches.

"It follows that the choice of whether to prescribe atovaquone-proguanil or doxycycline (or, exceptionally, mefloquine) should be made by health professionals through taking into account additional factors such as cost, known contraindications to any of the drugs in question (for example, pregnancy, breast-feeding, age), known rare serious adverse events, previous use of the drugs, possible drug-drug interactions, ease of administration, and travel itinerary," the authors conclude.

A co-author was an investigator for one of the included trials.

Abstract
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