[Danger of malaria self-treatment. Acute neurologic toxicity of mefloquine and its combination with pyrimethamine-sulfadoxine].
BACKGROUND
Mefloquine and pyrimethamine-sulfadoxine combination are recommended, as is quinine, for self-administered malaria prophylaxis. Patients should be carefully informed about appropriate use of this therapeutic scheme and advised on the importance of strict compliance to avoid overdose.


METHODS
We report the case of a patient who did not follow the prescribed dosage and who developed acute neurological disorders after overdosing. The patient developed seizures attributable to the sulfadoxine-pyrimethamine combination and mefloquine encephalopathy.


CONCLUSIONS
Sulfadoxine-pyrimethamine-related seizures are exceptional and result from an overdose of pyrimethamine. The neurotoxicity of mefloquine is well-known and is particularly frequent at curative dosage. Toxic encephalopathy is a serious neurological manifestation which is slowly reversible depending on individual predisposition. Anti-malaria prophylaxis requires concerted efforts on the part of the traveler and the prescribing physician. Self-administration schemes can be both most useful and dangerous due to expected benefits and potential risks.
Nicolas
X
X
Service de Médecine interne, Hôpital d'Instruction des Armées Clermont-Tonnerre, Brest Naval. xfnicolas@hotmail.com
Granier
H
H
Laborde
J P
JP
Martin
J
J
Talarmin
F
F
D000328:Adult; D004338:Drug Combinations; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D015767:Mefloquine / Q000009:adverse effects* / Q000031:analogs & derivatives; D011739:Pyrimethamine / Q000009:adverse effects*; D012651:Self Medication; D013413:Sulfadoxine / Q000009:adverse effects*; D000096926:Benzenesulfonamides
D004338:Drug Combinations; D015767:Mefloquine; D011739:Pyrimethamine; D013413:Sulfadoxine; C046846:mefloquine-sulfadoxine-pyrimethamine; D000096926:Benzenesulfonamides