Adverse Events Of Atovaquone-Proguanil Compared With Mefloquine as Malaria Chemoprophylaxis Used By Visitors Of Malaria Endemic Country : A Systematic Review And Meta Analysis
Bibliographic record
Abstract
Introduction: Chemoprophylaxis plays a crucial role in preventing malaria among travellers to endemic regions. Atovaquone-proguanil and mefloquine are two of the main chemoprophylactic agents recommended by the WHO and CDC to prevent malaria. Both are effective in malaria prophylaxis but are associated with distinct adverse events that can influence their use in travellers. Method: Literature search was conducted in ScienceDirect, and PubMed databases until 2025 without language constraints. Inclusion criteria focused on studies assessed the use of both atovaquone-proguanil and mefloquine as malaria prophylaxis in visitors to malaria-endemic countries. The risk of bias was evaluated using TheNewcastle-Ottawa Scale and Cochrane "RoB" tool. Discussion: A total of 10 studies were included and resulting in 15 categories of adverse events. Reported events were diarrhea (RR 1.07; 95% CI; p = 0.72) mouth ulcers (RR 2.88; 95% CI; p = 0,32), indigestion (RR 1.17; 95% CI; p = 0.80), abdominal pain (RR 1.41; 95% CI; p = 0.10), vomiting & Nausea (RR 0.64; 95% CI; p = 0.16), insomnia (RR 0.25; 95% CI; p = 0.007), dizziness/vertigo (RR 0.41; 95% CI; p = 0.02), tinnitus (RR 0.70, 95% CI; p < 0.00001), anxiety (RR 0.13; 95% CI; p < 0.00001), depression (RR 0.20; 95% CI; p < 0.00001), nightmares (RR 0.18; 95% CI; p = 0.001), headaches (RR 0.47; 95% CI; p = 0.003), dermatological effects (RR 0.89; 95% CI; p = 0.74), eye disorders (RR 0.42; 95% CI; p = 0.02), and a pooled analysis along with events not specifically mentioned (RR 0.38; 95% CI; p = 0.33). Heterogeneity among included studies was generally low to moderate. Conclusion: Practically, mefloquine is suitable for long-term weekly prophylaxis except for those with psychiatric disorders, whereas atovaquone-proguanil is preferred for short-term travel with the recommendation to administer it with food.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.039 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".