Antimalarial Drugs for Soldiers in East Timor Under the Microscope
Malaria remains a major cause of suffering and deaths worldwide, including in the military. Many Australian soldiers serving in East Timor contracted the disease, possibly due to poor compliance with their daily preventive medication.
Mefloquine, which is taken weekly, is also recommended for malaria prevention, but there has been controversy about its side effects. The current issue of the Medical Journal of Australia publishes research results showing that a weekly dose of mefloquine was generally well tolerated by Australian soldiers and provides an alternative for malaria prevention. Mefloquine is licensed in Australia for prophylaxis against malaria.
Associate Professor Scott Kitchener, of the Centre for Military and Veterans' Health, Mayne Medical School, Herston in Queensland, and colleagues from the Army Malaria Institute in Queensland, undertook an enhanced surveillance which monitored the tolerability of mefloquine and doxycycline in two contingents of Australian soldiers, each deployed to East Timor for peacekeeping duties over a 6-month period (April 2001-October 2001 and October 2001-May 2002).
Of 1157 soldiers starting on mefloquine, 75 withdrew because of adverse responses to the drug.
"There were three serious adverse events of a neuropsychiatric nature, possibly relating to mefloquine. Fifty-seven per cent of soldiers using mefloquine prophylaxis reported at least one adverse event, compared with 56 per cent using doxycycline," Associate Professor Kitchener said.
The most commonly reported adverse events of both doxycycline and mefloquine were sleep disturbance, headache, tiredness and nausea.
"Of the 968 soldiers still taking mefloquine at the end of their deployments, 94 per cent indicated they would use mefloquine again. Of the 388 soldiers taking doxycycline prophylaxis who were deployed with the first mefloquine study contingent, 89 per cent indicated they would use doxycycline again.
"Mefloquine was generally well tolerated by Australian soldiers and could continue to be used for those intolerant of doxycycline.
"As Australian soldiers will continue to exercise in and be deployed to malaria-endemic areas, there is a continuing need to seek out effective and well tolerated antimalarial drugs and to maintain alternative chemoprophylactic options," Associate Professor Kitchener said.
In an editorial in the same issue of the Journal, Professor James McCarthy, Associate Professor of Tropical Medicine and Infectious Diseases at the University of Queensland, emphasises that no drug for malaria prevention is 100% effective and that mosquito avoidance is therefore important. In view of the side effects and compliance problems with drugs for malaria prevention, developing an effective vaccine suitable for non-immune soldiers, travellers and the even larger population of residents of malaria-endemic countries remains a priority.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Associate Professor Scott KITCHENER, 0407 366 733
Dr James McCARTHY, 0414 424 659 / 07 3845 3796
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471