Antimalarial chemoprophylaxis and the risk of neuropsychiatric disorders. Schneider, C., Adamcova, M., Jick, S. S., Schlagenhauf, P., Miller, M. K., Rhein, H., & Meier, C. R. Travel Medicine and Infectious Disease, 11(2):71--80, April, 2013.
doi  abstract   bibtex   
BACKGROUND: Case reports and epidemiological studies have associated the use of mefloquine with neuropsychiatric adverse events. METHODS: We used the General Practice Research Database to conduct a follow-up study with a nested case-control analysis. We assessed the risk of developing first-time anxiety, stress-related disorders/psychosis, depression, epilepsy or peripheral neuropathies in patients using mefloquine, chloroquine and/or proguanil, or atovaquone/proguanil for malaria chemoprophylaxis, as compared to unexposed travelers. RESULTS: Compared to non-users of antimalarials, the adjusted odds ratio in the nested case-control analysis for users of mefloquine, chloroquine and/or proguanil, or atovaquone/proguanil were 0.71 (95% CI 0.56-0.90), 1.04 (95% CI 0.74-1.46), and 0.73 (95% CI 0.61-0.86) for anxiety or stress-related disorders combined, 0.54 (95% CI 0.41-0.71), 1.06 (95% CI 0.71-1.59), and 0.75 (95% CI 0.62-0.91) for depression, 0.69 (95% CI 0.35-1.36), 1.41 (95% CI 0.54-3.67), and 0.75 (95% CI 0.42-1.36) for epilepsy, and 1.22 (95% CI 0.50-2.99), 1.59 (95% CI 0.41-6.15), and 1.05 (95% CI 0.54-2.03) for neuropathies, respectively. The risk of all outcomes was higher in females than in males across all exposure categories. CONCLUSIONS: The risk of neuropsychiatric disorders was similar for users and for non-users of anti-malarial chemoprophylaxis, with evidence for elevated risks in some subgroups.
@article{schneider_antimalarial_2013,
	title = {Antimalarial chemoprophylaxis and the risk of neuropsychiatric disorders},
	volume = {11},
	issn = {1873-0442},
	doi = {10.1016/j.tmaid.2013.02.008},
	abstract = {BACKGROUND: Case reports and epidemiological studies have associated the use of mefloquine with neuropsychiatric adverse events.
METHODS: We used the General Practice Research Database to conduct a follow-up study with a nested case-control analysis. We assessed the risk of developing first-time anxiety, stress-related disorders/psychosis, depression, epilepsy or peripheral neuropathies in patients using mefloquine, chloroquine and/or proguanil, or atovaquone/proguanil for malaria chemoprophylaxis, as compared to unexposed travelers.
RESULTS: Compared to non-users of antimalarials, the adjusted odds ratio in the nested case-control analysis for users of mefloquine, chloroquine and/or proguanil, or atovaquone/proguanil were 0.71 (95\% CI 0.56-0.90), 1.04 (95\% CI 0.74-1.46), and 0.73 (95\% CI 0.61-0.86) for anxiety or stress-related disorders combined, 0.54 (95\% CI 0.41-0.71), 1.06 (95\% CI 0.71-1.59), and 0.75 (95\% CI 0.62-0.91) for depression, 0.69 (95\% CI 0.35-1.36), 1.41 (95\% CI 0.54-3.67), and 0.75 (95\% CI 0.42-1.36) for epilepsy, and 1.22 (95\% CI 0.50-2.99), 1.59 (95\% CI 0.41-6.15), and 1.05 (95\% CI 0.54-2.03) for neuropathies, respectively. The risk of all outcomes was higher in females than in males across all exposure categories.
CONCLUSIONS: The risk of neuropsychiatric disorders was similar for users and for non-users of anti-malarial chemoprophylaxis, with evidence for elevated risks in some subgroups.},
	language = {eng},
	number = {2},
	journal = {Travel Medicine and Infectious Disease},
	author = {Schneider, Cornelia and Adamcova, Miriam and Jick, Susan S. and Schlagenhauf, Patricia and Miller, Mary K. and Rhein, Hans-Georg and Meier, Christoph R.},
	month = apr,
	year = {2013},
	pmid = {23541791},
	keywords = {Adolescent, Adult, Aged, Antimalarials, Chemoprevention, Child, Child, Preschool, Female, Great Britain, Humans, Infant, Malaria, Male, Mental Disorders, Middle Aged, Odds Ratio, Risk, Travel, incidence},
	pages = {71--80}
}

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