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Malaria
spreads through the bite of the mosquito.
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Photo
courtesy Steve Doggett
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By
LS Rachel Irving
The
ADF is taking a conservative approach to the use of the anti-malaria
drug mefloquine following concerns raised over its side-effect
profile by the US Department of Defense.
Mefloquine has been most recently linked to vestibular dysfunctions
(balance disorders) in nearly a dozen cases of US service members
returning from Op Enduring Freedom and Op Iraqi Freedom.
While other causes for the disorder are being investigated, such
as loud noises, jet fuel and explosives, 10 out of 11 patients
under review took the drug mefloquine.
Vestibular adverse events are widely recognised and this is one
reason why the drug is not recommended for aircrew and those involved
in flying operations.
The vast majority of Defence personnel who have served or are
serving in malarial regions, such as those on Op Anode, would
have been prescribed Doxycycline, though there are still arguments,
from a command perspective, for the use of mefloquine as it could
be more easily administered and monitored.
Mefloquine, a product of US Army research, has been investigated
in the past for its psychological effects on patients.
There have been questions raised, though no substantial proof,
linking mefloquine to violent episodes and suicide.
DGADF Defence Health Services AIRCDRE Tony Austin said that while
the official US position is there is no link between violence
and mefloquine, it is something the ADF is very mindful of.
“Our approach is always to minimise the risk of adverse events
for all our members. We will always go for the safest possible
option for the shortest period of time,” AIRCDRE Austin said.
“The issue coming out of the Middle East and Afghanistan of psychiatric
effects with possible links to an increase in violence and suicide
is very difficult to determine.
“You have sent people to a war zone so it is difficult to say
whether it is the stressful environment which is the trigger or
the drug.
But the fact that there are questions over the drug is enough
for the ADF not to use it as their frontline drug of choice and
to limit and monitor its use.”
AIRCDRE Austin said that the Australian military experience with
mefloquine, or Larium as it is more commonly referred to in Australia,
is minimal although mefloquine was studied in two battalions in
East Timor (2RAR and 4RAR) and was also used as a comparator in
a trial of Tafenoquine.
“The drug is not our preferred choice within the ADF though it
is recommended by the World Health Organisation (WHO) and approved
by the Australian Therapeutic Goods Administration and is in fact
still the drug of choice by many civilian travellers,” AIRCDRE
Austin said.
“The Army Malaria Institute (AMI) conducted research on mefloquine
but has elected to recommend Doxycycline as the preferred frontline
treatment for anti-malaria in the ADF.”
AIRCDRE Austin said mefloquine is a world recognised drug as an
anti-malaria prevention working on a weekly dose which makes it
attractive for travellers.
However it is the possible side effects of mefloquine that are
of most concern to the ADF.
“As a result of the information coming out of the US on the use
of mefloquine, we are becoming even more conservative with our
use of that particular drug.
That is not to say that we are convinced that there are significant
problems with the use of the drug but we are being conservative
until absolutely sure.”
Mefloquine is only used in small numbers in the ADF when members
are unable to tolerate Doxycycline though the ADF has ramped up
the warnings given to people who go on to mefloquine and personnel
who require the drug undergo trial loading doses before any deployment.
If members have any concerns they should speak with their ADF
medical officer.
