[mona]

Well actually, the evidence for mefloquine (Lariam) is pretty good in terms of its efficacy at preventing the contraction of malaria (i.e the systematic review or the randomised controlled trials performed were probably not subsidised by Roche or any other pharmaceutical company). The main reason for prescribing mefloquine over other more traditional anti-malarials is due to the emergence of resistant strains. Now, Bangladesh must have documented resistant strains and that's probably why the GP was so hot to prescribe it without really knowing the prevalence of the disease. Unfortunately the evidence is quite as good at identifying that the side effects of mefloquine are quite serious and more common than we would like especially, it seems, in women. For that reason, it's contraindicated for people with existing psychiatric disorders.

A recent article in the New England Journal of Medicine (N Engl J Med 2008 Aug 7;359(6):603-12) has this to say about mefloquine safety:

Safety of Mefloquine
Neuropsychiatric and other adverse events due to mefloquine (Table 3) have received widespread media attention. Mefloquine has been used by more than 30 million persons since 1989, and a large published database exists.244142434445 In doses used for chemoprophylaxis, severe side effects such as seizures and psychosis occur rarely (in approximately 1 of 6500 to 1 of 10,600 persons using the drug).4647 The rates of less serious but potentially disruptive neuropsychological problems (e.g., insomnia, nightmares, irritability, and depression) appear to be in the range of 1 per 200 to 1 per 500 users 2645; however, data on rates of these symptoms among travelers who are not receiving mefloquine remain inadequate.45 Vivid dreams occur in 15 to 25% of users, but they are generally tolerable. Overall, approximately 95% of mefloquine users are able to complete the prescribed course of treatment.

The moral of the story is, samjad, just because you and your wife both had adverse events in response to the Lariam (which, if you look at the statistics, is amazing.. do you play the lotto? you should), doesn't mean everyone else will. The point of starting the meds one week before you leave is to see it's adverse effect profile so you can stop it before you leave like you've just done. I might add that there's nothing wrong with protecting yourself medically if it's tolerable, even if you're facing a low risk, and that unfortunately dengue isn't preventable that way yet so there's no point comparing.

Here are some trials that have been done related to mefloquine:
- Mefloquine compared with doxycycline for the prophylaxis of malaria in Indonesian soldiers. A randomized, double-blind, placebo-controlled trial
- Atovaquone plus chloroguanide versus mefloquine for malaria prophylaxis: a focus on neuropsychiatric adverse events.
- Atovaquone-proguanil versus mefloquine for malaria prophylaxis in nonimmune travelers: results from a randomized double-blind study

Anyway, samjad, hope you and your wife recover soon and enjoy your malaria-and-dengue-free time in Bangladesh.