Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria

Trans R Soc Trop Med Hyg. Sep-Oct 1997;91(5):574-7. doi: 10.1016/s0035-9203(97)90032-8.

Abstract

On the western border of Thailand, in an area endemic for multi-drug resistant Plasmodium falciparum malaria, therapeutic responses were assessed in 1967 patients with uncomplicated falciparum malaria treated with 3 d of artesunate (total dose 12 mg/kg) plus mefloquine (total dose 25 mg/kg). The regimen was well tolerated and resulted in a rapid clinical response; within 48 h, 96% of patients were aparasitaemic and 94% were afebrile. After correcting for reinfections, the cure rate by day 42 was 89% (95% confidence interval [95% CI] 87-91%). Three independent factors were found to predict recrudescence: age < 14 years (adjusted hazards ratio [AHR] = 1.6, 95% CI 1.1-2.3), initial parasitaemia greater than > 40,000/microL (AHR = 1.6, 95%, CI 1.2-2.2), and pure P. falciparum infections (AHR = 1.8, 95% CI 1.3-2.7). These 3 factors combined accounted for 62% of all treatment failures. Patients who received mefloquine on admission with a high admission parasitaemia (> 40,000/microL) had a three-fold (95% CI 1.3-7) risk of subsequent recrudescence compared with those who received their mefloquine on the second or third day (P = 0.01). There has been no decline in the efficacy of the 3 d artesunate plus mefloquine regimen since it was introduced in 1992. This regimen is safe, well tolerated, and highly effective in the treatment of multi-drug resistant falciparum malaria.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antimalarials / adverse effects
  • Antimalarials / therapeutic use*
  • Artemisinins*
  • Artesunate
  • Child
  • Child, Preschool
  • Drug Resistance, Multiple*
  • Drug Therapy, Combination
  • Endemic Diseases
  • Female
  • Fever / drug therapy
  • Follow-Up Studies
  • Humans
  • Infant
  • Malaria, Falciparum / drug therapy*
  • Male
  • Mefloquine / adverse effects
  • Mefloquine / therapeutic use*
  • Middle Aged
  • Parasitemia / drug therapy
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Sesquiterpenes / adverse effects
  • Sesquiterpenes / therapeutic use*
  • Thailand
  • Treatment Outcome

Substances

  • Antimalarials
  • Artemisinins
  • Sesquiterpenes
  • Artesunate
  • Mefloquine