Background: We wanted to determine the frequency of side effects and compliance with mefloquine and chloroquine used for antimalarial prophylaxis in children 0 to 13 years compared with side effects in same-age children taking prophylactic chloroquine.
Methods: Subjects and treatment were identified by retrospective medical record review for children < or = 13 years not on other medications who visited a travel clinic between November 1997 and January 2000. Parents were interviewed via telephone in January through March 2000 regarding compliance and side effects.
Results: We reviewed 286 records and contacted 190 of 286 parents (66%). Of these, 177 (93%) parents had first-hand knowledge about the child's compliance with the medication regimen and were interviewed. Subjects were 47% male (median age 6.3 years), contacted a median of 12.4 months (range 2.8 to 28 months) following their clinic visit. Of these, 148 (84%) were prescribed mefloquine, and 29, chloroquine with 77% (136/177) taking the prescribed antimalarial. Most children (30 of 41 [73%]) not receiving their prophylaxis traveled unprotected to endemic area. Sixteen subjects (12% of those taking antimalarials) reported side effects. Eleven of 115 subjects (10%) who took mefloquine, and 5 of 22 subjects (23%) who took chloroquine reported a side effect. Side effects for mefloquine included diarrhea, anorexia, vivid dreams, headache, changes in sleep, hallucinations, and vomiting with 2 subjects stopping mefloquine after seeking medical care. Side effects for chloroquine were headache, nausea, and changes in sleep. No child stopped taking chloroquine. Groups reporting or not reporting a side effect were similar for gender, age, travel destination, antimalarial prescribed, and elapsed time from clinic visit to telephone contact.
Conclusions: Side effects from antimalarial drug administration occurred in 10 to 23% of patients who took their medication but rarely resulted in stopping prophylaxis. Prescribed antimalarials were sometimes never given. Appropriate counseling on side effects and reasons for faithful administration should accompany antimalarial prophylaxis.