By
LS Rachel Irving
THE
ADF is taking a conservative approach to the use of the anti-malaria
drug mefloquine after the US Department of Defense raised concerns
about its side-effects. Mefloquine has been most recently linked
to vestibular dysfunctions, or balance disorders, in nearly a
dozen US service members returning from Operations Enduring Freedom
and Iraqi Freedom.
While other causes for the disorders are being investigated, such
as loud noises, jet fuel and explosives, 10 out of 11 patients
under review took the drug mefloquine. The balance disorder is
widely recognised and is one reason why the drug is not recommended
for aircrew and those involved in flying operations. Mefloquine,
a product of US Army research, also 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. Director-General
ADF Health Air Commodore Tony Austin said the ADF’s 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.” “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,” he said.
“You have sent people to a war zone so it is almost impossible
to say whether it is the stressful environment which is the trigger
or the drug. But the fact 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 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 and approved by
the Australian Therapeutic Goods Administration and is in fact
still the drug of choice by many civilian travellers,” he said.
The vast majority of Defence personnel who have served or are
serving in malarial regions, such as those on Operation Anode,
would have been prescribed Doxycycline. AIRCDRE Austin said that
mefloquine was a world-recognised drug as an anti-malaria prevention
working on a weekly dose that makes it attractive for travellers.
However, the possible side-effects of mefloquine are of most
concern to the ADF. The ADF constantly monitors literature so
it is aware of problems as they occur and reviews its policies
accordingly. If members have any concerns they should speak with
their medical officer.
