Schistosomiasis artesunate, or mefloquine. A Cochrane review found tentative evidence that when used alone, metrifonate was as effective as praziquantel. Another agent, mefloquine, which has previously been used to treat and prevent malaria, was recognised in 2008–2009 to be effective against "Schistosoma". Historically, antimony potassium tartrate remained the treatment of choice for schistosomiasis until the development of praziquantel in the 1980s. The disease is found in tropical countries in Africa, the Caribbean, eastern South America, Southeast Asia, and the Middle East. "S. mansoni" is found in parts of South America and the Caribbean, Africa, and the Middle East; "S. haematobium" in
Mefloquine with an increased risk of birth defects or miscarriages. The drug may be used during breastfeeding, though it appears in breast milk in low concentrations. The World Health Organization gives approval for the use of mefloquine in the second and third trimesters of pregnancy and use in the first trimester does not mandate termination of pregnancy. Mefloquine is metabolized primarily through the liver. Its elimination in persons with impaired liver function may be prolonged, resulting in higher plasma levels and an increased risk of adverse reactions. The mean elimination plasma half-life of mefloquine is between two and four weeks. Total