Introduction: Chemoprophylaxis plays a crucial role 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 event that can influence their use in travellers. Method: Comprehensive literature search was conducted in ScienceDirect, and PubMed databases until May 20, 2025 without language constraints. Inclusion criteria comprised several factors: studies assessed the use of both atovaquone-proguanil and mefloquine malaria prophylaxis in visitors to malaria-endemic areas for the purpose of preventing malaria. Discussion: A total of 10 studies were included and resulting of 15 categories of adverse events. The results showed that in several categories of adverse events there were significant differences between the side effects of the two drugs. Reported events were diarrhea (p = 0.72) mouth ulcers (p = 0,32), indigestion/stomach problems (p = 0.80), abdominal pain (p = 0.10), vomiting & Nausea (p = 0.16), insomnia (p = 0.007), dizziness/vertigo (p = 0.02), tinnitus (p < 0.00001), anxiety (p < 0.00001), depression (< 0.00001), nightmares (p = 0.001), headaches (p = 0.003), dermatological effects (p = 0.74), eye disorders (p = 0.02), and a pooled analysis along with events not specifically mentioned (p = 0.33). Heterogeneity among included studies was generally low to moderate. Conclusion: Mefloquine is more frequently associated with neuropsychiatric and visual adverse effects. In contrast, atovaquone-proguanil is more commonly linked to gastrointestinal issues.
Tammubua et al. (Sun,) studied this question.
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