The following article was written by a Kathleen Doheny and appeared in
the Los Angeles Times March 23.

"Stick with the Malaria Medicine."

During the first half of his semester in Africa last year, Matthew
Nelson took his prescription antimalarial, mefloquine (Lariam), each
week on schedule.
But then the 20-year-old Pomona College student noticed some
troublesome side effects and blamed them on the medicine. On Sundays,
the day he took the medicine he said he felt depressed. "I was having
some stomach problems that I thought might be related," he said.
Halfway through the school term, he stopped taking mefloquine and felt
better.
Other travelers share Nelsons's concerns over side effects from
mefloquine, although public health officals consider the drug generally
safe and effective.
In Brittain, three consumers have taken legal action agaist Roche
Products Ltd., the British manufacturer of Lariam, seeking as yet
unspecified damages due to the effects of the medicine.  Recently, the
trio was given more time to gather data, said a Roche spokeswoman.
There are no lawsuits against the manufacturer filed by U.S. consumers
"as far as I know," said Diane Donlon, spokeswoman for Hoffman LaRoche
Inc., the U.S. manufacturer in Nutley, N.J. Nor, to her knowledge, no
deaths have been attributed to the drug, which went on the U.S. market
in 1990.
Despite the legal action overseas, mefloquine is recommended by the
federal Centers for Disease Control. "The drug is generally
well-tolerated," said Dr. Hans Lobel, chief of the Malaria Surveilance
Unit, division of parasitic diseases at the CDC. He calls it the drug
of choice for malaria prevention. "The drug has been studied in more
than 70,000 subjects", said Lobel, who has conducted some of those
studies, and used by more than 12 million people."
Malaria is spread by the bite of infected female Anopheles mosquitoes.
It strikes about 500 million people a year worldwide and kills 2.7
million annually. The disease is caused by parasites consisting of
single cells, or protozoa, called Plasmodium, of which there are four
species. Infectons by one of them, P.falciparum, can lead to kidney
failure, coma and death.
Combating malaria has been a tough battle. In the 190s, the disease was
eliminated from many temperate zone countries. But then the infecton
resurged in many tropical regions. Now malaria occurs in more than more
90 countries, according to the World Health Organization. Transmission
now occurs in large areas of Central and South America, Hispaniola,
sub-Saharan Africa, the Indian subcontinent, Southeast Asia, the Middle
East and Oceania, according to the CDC. No areas of the U.S. are
considered at risk for malaria, according to the CDC.
Lariam became an especially valuable tool as the falciparum parasite
developed resistance to chloroquine (Aralen), another antimalarial.
"The risk of getting malaria is greater than the risk of side effects
(from Lariam)," said Dr. Victor Kovner, a Studio City internist who
focuses on travel medicine and evaluated Nelson upon his return.
"Larima's bad reputation is very much undeserved."
Travelers to malaria-stricken areas should start taking mefloquine one
to two weeks before departure, Kovner suggested. This will help
determine if a traveler can tolerate it well or should switch to
another medicine.
During the trip, the mefloquine should be taken once a week for four
weeks. Four additional weekly doses are recommended after a traveler's
return.
Among possible side effects listed on the package insert are dizziness,
a disturbed sense of balance and psychiatric reactions. Users who
notice unexplained anxiety, depression or confusion are advised to
discontinue the drug. Other side effects reported included vomiting (3%
of users) and dizziness, fainting and premature heart contractions
(1%). Others have reported visual disturbances.
About one in 10,000 users has a serious side iffect (requiring
hospitalization), according to a spokesman for Hoffman LaRoche.
In one of his studies, the CDC's Lobel compared three antimalarial
regimens - mefloquine, chloroquine only and chloroquine and proguanil,
another antimalaial - among about 500 Peace Corps volunteers in half a
dozen West African countries from 1989 to 1991.
"Mefloquine was close to 100% effective," he said, while the other
regimens were not. He asked volunteers to complete questionaires about
their sumptoms every four monts. "From those, it appeared that 30% or
40% of all volunteers complained of something (side effects)."
Researchers at Walter Reed Army Institute of Research, working with
SmithKline Beecham Biologicals, say an experimental vaccine that
protects against malaria and the hepatitis B virus is showing promise.
The vaccine was 80% effective in a test on 6 volunteers, according to a
report earlier this year in the New England Journal of Medicine. More
studies are planned.
For more information on malaria prevention and treatment, call the CDC
at (404) 332-4555.

Best, Peter
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