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After attending a conference in 2020 about effects of anti-malarial drugs, Nelson suspected he may have experienced mefloquine toxicity and pursued testing that confirmed the diagnosis.

Texas adopted a similar rule on Friday that included another malaria drug — mefloquine — as well as the antibiotic azithromycin, commonly known by its brand name, Zithromax Z-Pak.

Texas has also limited prescriptions of the antibiotic azithromycin as well as another anti-malarial drug, mefloquine.

One option is to switch the companion drug from piperaquine to an older drug that is still effective, mefloquine, he said.

Malaria experts have been encouraged because so far, parasites resistant to piperaquine are still susceptible to an older drug, mefloquine, that has regained its efficacy after years on the shelf.