Treatment of multidrug-resistant Plasmodium falciparum malaria with 3-day artesunate-mefloquine combination.

Journal article

Studies of 652 adults and children with acute uncomplicated falciparum malaria were done to determine the optimum treatment of multidrug-resistant Plasmodium falciparum malaria on the Thai-Burmese border. Single-dose artesunate (4 mg/kg) plus mefloquine (25 mg of base/kg) gave more rapid symptomatic and parasitologic responses than high-dose mefloquine alone but did not improve cure rates. Three days of artesunate (total dose, 10 mg/kg) plus mefloquine was 98% effective compared with a 28-day failure rate of 31% with high-dose mefloquine alone (relative risk [RR], 0.06; 95% confidence interval [CI], 0.02-0.2; P < .0001). By day 63, the reinfection adjusted failure rates were 2% and 44%, respectively (P < .0001). Artesunate also prevented high-grade failures. Both drugs were well tolerated. No adverse effects were attributable to artesunate. Vomiting was reduced significantly by giving mefloquine on day 2 of treatment (RR, 0.40; 95% CI, 0.20-0.79; P = .009. Artesunate (10 mg/kg over 3 days) plus mefloquine (25 mg/kg) is currently the most effective treatment for falciparum malaria in this area of increasing mefloquine resistance.

Authors: Nosten, F; Luxemburger, C; ter Kuile, F; Woodrow, C; Eh, J

• Publication status: Published
• Journal: Journal of infectious diseases
• Volume: 170
• Issue: 4
• Pages: 971-977
• Publication date: 1994-10-01
• DOI: 10.1093/infdis/170.4.971
• EISSN: 1537-6613
• ISSN: 0022-1899
• Language: English
• Keywords: Adult; Child; Antimalarials; Mefloquine; Animals; Time Factors; Follow-Up Studies; Artemisinins; Drug Therapy, Combination; Plasmodium falciparum; Disease-Free Survival; Thailand; Sesquiterpenes; Malaria, Falciparum; Humans; Myanmar; Drug Administration Schedule; Drug Resistance, Multiple; Recurrence