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To the Editor.—Drs Lobel and Kozarsky¹ provide us with their clinical opinion that mefloquine is the drug of choice for most travelers going to malarious areas, but they do not systematically summarize the evidence that led them to this conclusion. We sought systematically available evidence in randomized trials (searching from 1966 to September 1997) and identified 37 possible studies, 10 of which met our prespecified inclusion criteria.^2-3 Our review identified as a primary outcome the numbers of participants withdrawing during the study period. This end point is a more reliable indicator of toxicity than reported symptoms as withdrawal indicates that a threshold of tolerability has been reached.⁴

In placebo-controlled studies, the pooled analysis showed that there were significantly more withdrawals in the mefloquine group compared with the placebo group (4.4% vs 1.1%, respectively; absolute risk of withdrawal, 3.3%; 95% confidence interval, 0.6%-6.0%). In comparisons between mefloquine and other regimens, . . . [Full Text of this Article]

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