Single dose artemisinin-mefloquine treatment for acute uncomplicated falciparum malaria.
For the treatment of patients with acute falciparum malaria, the combination of artemisinin as a single dose with a single dose of mefloquine was studied in 4 separate prospective trials, comprising 405 adults and 139 children with uncomplicated falciparum malaria in 2 in-patient and 2 rural out-patient studies in Viet Nam. Adults received oral artemisinin and children artemisinin suppositories. Randomized comparative treatment schedules were: artemisinin alone for 5 d, mefloquine-sulfadoxine-pyrimethamine (MSP), or quinine plus sulfadoxine-pyrimethamine (SP). Parasite clearance times (PCT) were rapid for artemisinin treated inpatients (90%: 14.8-20.4 h) but also for patients receiving MSP (PCT 90%: 18.0 h) and quinine (PCT 90%: 22.5 h). The recrudescence rate (RI) during a 28 d follow-up period among the patients given artemisinin plus mefloquine was 15% in the adult in-patients and zero in the adult and children out-patients. RI in the artemisinin 5 d treatment group was 33.3%; among those given artemisinin plus SP it was 47.3% in in-patients and in out-patients 46.1%. In the MSP treated out-patients RI was 1.5% in adults and zero in children. Artemisinin as a single dose (oral in adults and as a suppository in children) in combination with mefloquine was effective in rapidly lowering parasitaemia and in preventing recrudescence in hospital in-patients and in out-patients attending a rural health clinic. MSP alone as a single dose also rapidly reduced parasitaemia (but not as quickly as the artemisinin-mefloquine combination in out-patient children) and prevented recrudescence.
Tran
T H
TH
Centre for Tropical Diseases (Cho Quan Hospital), Ho Chi Minh City, Viet Nam.
Arnold
K
K
Nguyen
T H
TH
Pham
P L
PL
Nguyen
T D
TD
Bui
M C
MC
Le
M T
MT
Mach
Q P
QP
Le
H V
HV
Pham
P M
PM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use; D011803:Quinine / Q000627:therapeutic use; D012717:Sesquiterpenes / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use; D013488:Suppositories
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D013488:Suppositories; D013413:Sulfadoxine; C031327:artemisinin; D011803:Quinine; D015767:Mefloquine; D011739:Pyrimethamine