Treatment of multidrug-resistant Plasmodium falciparum malaria with 3-day artesunate-mefloquine combination.
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.
Nosten
F
F
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Luxemburger
C
C
ter Kuile
F O
FO
Woodrow
C
C
Eh
J P
JP
Chongsuphajaisiddhi
T
T
White
N J
NJ
D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins; D000077332:Artesunate; D002648:Child; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D015767:Mefloquine / Q000627:therapeutic use*; D002052:Myanmar; D010963:Plasmodium falciparum / Q000187:drug effects; D012008:Recurrence; D012717:Sesquiterpenes / Q000627:therapeutic use*; D013785:Thailand; D013997:Time Factors
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine