title: Mefloquine at the crossroads? Implications for malaria chemoprophylaxis in Europe.
abstract: Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis. This commentary looks at the current position of mefloquine prescribing and the rationale of the new EMA recommendations and restrictions. It also describes the new recommendations for malaria prophylaxis that have been adapted by Switzerland, Germany, Austria and Italy where chemoprophylaxis use is restricted to high-risk malaria-endemic areas.
authors.affiliation: University of Zürich Centre for Travel Medicine, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, CH-8001 Zürich, Switzerland. Electronic address: pat@ifspm.uzh.ch.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
authors.affiliation: University of Zürich Centre for Travel Medicine, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, CH-8001 Zürich, Switzerland; Swiss Tropical and Public Health Institute, PO Box, CH-4002 Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: Hospital for Tropical Diseases Mortimer Market, & London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ron
authors.initials: R
authors.lastname: Behrens
authors.affiliation: Leiden University Medical Center, Department of Infectious Diseases, C5P-46, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Visser
authors.affiliation: University of Zürich Centre for Travel Medicine, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, CH-8001 Zürich, Switzerland.
authors.forename: Maia
authors.initials: M
authors.lastname: Funk
authors.affiliation: Medi24, Telemedicine Services, Allianz Global Assistance, Bolligenstrasse 54, CH-3006 Berne, Switzerland.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Holzer
authors.affiliation: Swiss Tropical and Public Health Institute, PO Box, CH-4002 Basel, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Beck
authors.affiliation: Office Fédéral de la Santé Publique OFSP, Berne, Switzerland.
authors.forename: Cathérine
authors.initials: C
authors.lastname: Bourquin
authors.affiliation: Kantonal Hospital, St. Gallen, Switzerland.
authors.forename: Hermann
authors.initials: H
authors.lastname: Etter
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, CH 3010 Bern, Switzerland.
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.affiliation: PMU|Policlinique Médicale Universitaire, Lausanne, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 6 rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Landry
authors.affiliation: Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 6 rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Francois
authors.initials: F
authors.lastname: Chappuis
authors.affiliation: Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 6 rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Louis
authors.initials: L
authors.lastname: Loutan
authors.affiliation: Swiss Int. Air Lines Ltd., Medical Services, 8058 Zurich Airport, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stössel
authors.affiliation: Medical University, Vienna, Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Jeschko
authors.affiliation: Centre for Tropical Diseases, "Sacro Cuore-Don Calabria" Hospital, Negrar, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossanese
authors.affiliation: University Hospital of Munich, Dep. of Infectious Diseases and Tropical Medicine, Leopoldstrasse 5, 80802 Munich, Germany.
authors.forename: Hans Dieter
authors.initials: HD
authors.lastname: Nothdurft
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D000075202:Contraindications; D005060:Europe; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control; D015767:Mefloquine / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D015767:Mefloquine
keywords: Adverse events; European Medicines Agency; Malaria prophylaxis; Mefloquine