title: Reversible binocular visual loss in temporal association with artesunate-amodiaquine treatment in a child on mefloquine chemoprophylaxis.
abstract: A case of an acute reversible visual loss in a 10-year-old child who was on mefloquine prophylaxis, and was treated with artesunate-amodiaquine for an acute febrile illness diagnosed clinically as uncomplicated malaria, is reported. On admission the patient could not perceive light and had bilateral papilloedema. She was treated with dexamethasone and recovered her sight gradually over a 21-day period. There has been no previous report to our knowledge, of an association between acute visual loss and mefloquine, amodiaquine, or artesunate in the published literature, even though mefloquine is associated with blurring of vision, and antimalarials of the quinoline class have been associated with retinopathy (during long term use). While causality is difficult to ascribe in this case, it may be prudent to avoid the use of quinoline-based antimalarials for treating acute malaria in travelers taking mefloquine prophylaxis, because information on the safety of concurrent use of artemisinin combination therapies and mefloquine, or other recommended prophylactic regimens, is limited.
authors: Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana Medical School, PO Box 4236, Accra, Ghana. goadjei@chs.edu.gh
authors: G O
authors: GO
authors: Adjei
authors: V M
authors: VM
authors: Adabayeri
authors: S H
authors: SH
authors: Annobil
mesh_terms: D000655:Amodiaquine / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000009:adverse effects*; D037621:Artemisinins / Q000009:adverse effects*; D018890:Chemoprevention; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control; D015767:Mefloquine / Q000627:therapeutic use; D013997:Time Factors; D014786:Vision Disorders / Q000139:chemically induced*; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; D003907:Dexamethasone; D015767:Mefloquine
references: J Travel Med. 2000 Jan;7(1):5-9
references: 10689231
references: BMJ. 2003 Nov 8;327(7423):1078
references: 14604928
references: Trop Med Int Health. 1996 Aug;1(4):485-94
references: 8765456
references: J Travel Med. 2008 Jul-Aug;15(4):278-80
references: 18666929
references: Antimicrob Agents Chemother. 2008 Dec;52(12):4400-6
references: 18779360
references: Br J Clin Pharmacol. 2004 Apr;57(4):506-12
references: 15025750
references: Semin Ophthalmol. 2008 May-Jun;23(3):201-9
references: 18432546
references: Trop Med Int Health. 1998 Feb;3(2):83-8
references: 9537268
references: N Engl J Med. 1992 Feb 27;326(9):581-8
references: 1734247
references: Lancet. 1996 Feb 3;347(8997):326
references: 8569381
references: J Neuroophthalmol. 2004 Sep;24(3):235-6
references: 15348992
references: Eur J Clin Pharmacol. 2002 Sep;58(6):441-5
references: 12242605
references: Ophthalmology. 2002 Sep;109(9):1679-84
references: 12208717
references: Eur J Clin Pharmacol. 2002 Aug;58(5):339-51
references: 12185558
references: JAMA. 2007 May 23;297(20):2251-63
references: 17519415
references: J Travel Med. 2001 May-Jun;8(3):148-9
references: 11468119