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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.

Space limitations in our article precluded addressing the question of terminal prophylaxis with primaquine, an 8-aminoquinoline that is selectively toxic to the pre-erythrocytic stages (tissue schizonts) of plasmodia in the liver and also kills the hypnozoites of P vivax and Plasmodium ovale.³ Blood schizonticides such as chloroquine and mefloquine will not prevent P vivax and P ovale . . . [Full Text of this Article]

Ashley M. Croft, MD
ashley.croft810@land.mod.uk
Headquarters Fifth Division
Shrewsbury, United Kingdom

Alicia H. Darbyshire, MD
Headquarters International Security Assistance Force
Kabul, Afghanistan

Christopher J. Jackson, MD
Camp Souter
Kabul, Afghanistan

Pieter P. van Thiel, MD
Academic Medical Center
University of Amsterdam
Amsterdam, the Netherlands

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