Tolerance of mefloquine alone and in combination with sulfadoxine-pyrimethamine in the prophylaxis of malaria.
A randomized double blind study was performed to evaluate the tolerance and the acceptance of mefloquine alone (Lariam) compared to a combined drug regimen consisting of mefloquine, sulfadoxine and pyrimethamine (MSP; Fansimef) in the prophylaxis of malaria. 175 Europeans travelling to different malaria endemic areas received either mefloquine alone (250 mg/week) or its combination with sulfadoxine (500 mg/week) plus pyrimethamine (25 mg/week). One person taking mefloquine and two taking MSP discontinued the drug intake because of moderate clinical side effects. Mild and moderate adverse clinical reactions predominantly concerning the gastro-intestinal tract and the autonomous nervous system were reported with a significantly higher occurrence in the MSP group. With both prophylactic regimens, reversibly elevated liver enzyme activities (glutamate oxalate transaminase and glutamate pyruvate transaminase [GPT]) were observed after prophylaxis. The increase of GPT serum activity correlated significantly with relatively high GPT levels before prophylaxis in both groups. This finding suggests a limited use of both regimens in cases of liver dysfunction. One case of mefloquine-resistant Plasmodium falciparum malaria was observed from West Africa; this patient was cured by a standard regimen of chloroquine.
Reisinger
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EC
Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Federal Republic of Germany.
Horstmann
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RD
Dietrich
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced; D004311:Double-Blind Method; D004338:Drug Combinations / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D015767:Mefloquine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008875:Middle Aged; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013413:Sulfadoxine / Q000009:adverse effects / Q000627:therapeutic use*; D013424:Sulfanilamides / Q000627:therapeutic use*; D000096926:Benzenesulfonamides
D000410:Alanine Transaminase; D000962:Antimalarials; D001219:Aspartate Aminotransferases; D004338:Drug Combinations; D015767:Mefloquine; D011739:Pyrimethamine; D013413:Sulfadoxine; D013424:Sulfanilamides; C046846:mefloquine-sulfadoxine-pyrimethamine; D000096926:Benzenesulfonamides