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Deaths and parasuicides associated with mefloquine chemoprophylaxis: A systematic review

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Tickell-Painter, Maya, Saunders, Rachel, Mayaan, Nicola, Lutje, Vittoria, Mateo-Urdiales, Alberto and Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 (2017) 'Deaths and parasuicides associated with mefloquine chemoprophylaxis: A systematic review'. Travel Medicine and Infectious Disease.

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Abstract

Background
Mefloquine is recommended in international health guidelines for preventing malaria in travellers. Reports of psychosis and suicide are often alluded to but are not clearly established.
Methods
We carried out a systematic review to identify and critically appraise any death or parasuicide associated with mefloquine prophylaxis. We developed a comprehensive search that included publications up to 11 July 2017. We included case studies but excluded newspaper reports. Two authors independently appraised each death or parasuicide against a standardised causality assessment tool. The protocol was registered on PROSPERO (CRD42016041988).
Results
We identified 527 articles that required full-text retrieval; of these 17 were unique publications that reported deaths or parasuicide. Eight unique publications had sufficient detail to be included in causality assessment. We identified 2 deaths with a probable association that appeared to be idiosyncratic drug reactions; we categorised the remaining 8 deaths as “unlikely” to be related to mefloquine, or “unclassifiable”. There was one parasuicide with a possible causal association. There were 9 additional publications that searched spontaneous drug reporting databases; none provided sufficient detail to perform a causality assessment.
Conclusions
Overall, the number of deaths that we could reliably attribute to the prophylactic use of mefloquine is very low.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21 Medicine as a profession.
QV Pharmacology > QV 56 Adverse effects (General)
WA Public Health > Preventive Medicine > WA 108 Preventive health services. Preventive medicine. Travel Medicine.
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
WB Practice of Medicine > Therapeutics > WB 330 Drug therapy
WM Psychiatry > WM 100 General works
WM Psychiatry > WM 140 Mental disorders (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.tmaid.2017.10.011
Depositing User: Stacy Murtagh
Date Deposited: 31 Oct 2017 17:14
Last Modified: 26 Oct 2018 01:02
URI: http://archive.lstmed.ac.uk/id/eprint/7778

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