title: Predictors of mefloquine treatment failure: a prospective study of 1590 patients with uncomplicated falciparum malaria.
abstract: The factors which identify patients at risk of treatment failure were characterized in 1590 children and adults with uncomplicated falciparum malaria treated with 15 or 25 mg/kg of mefloquine on the borders of Thailand. Six independent predictors of failure were identified using multiple logistic regression. Age < or = 2 years (odds ratio [OR] 4.54), 3-15 years (OR 4.4), vomiting < 30 min after a single dose of 25 mg/kg (despite re-administration of the dose) (OR 2.5) and diarrhoea after treatment (OR 3.6) were the strongest predictors of failure by day 7. Parasitaemias > 10 000/mm3 (OR 1.4), and fever with a history of recent vomiting (OR 1.6) were risk factors for recrudescence of the infection between days 10 and 28. Patients treated with mefloquine in the previous 2 months were also at increased risk of failure (OR 2.38), particularly if they were anaemic (haematocrit < 30%) (OR 5.96), which suggested that they had recrudescent infections at presentation. Combined, these 6 factors identified half of all treatment failures. Vomiting and diarrhoea accounted for 24% of the early failures in children. Patients at increased risk of treatment failure should be monitored closely and given early alternative treatment if fever and parasites persist for > or = 3 d.
authors.affiliation: Shoklo Malaria Research Unit, Mae Sod, Thailand.
authors.forename: F O
authors.initials: FO
authors.lastname: ter Kuile
authors.forename: C
authors.initials: C
authors.lastname: Luxemburger
authors.forename: F
authors.initials: F
authors.lastname: Nosten
authors.forename: K L
authors.initials: KL
authors.lastname: Thwai
authors.forename: T
authors.initials: T
authors.lastname: Chongsuphajaisiddhi
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000150:complications; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications / Q000188:drug therapy*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D014839:Vomiting / Q000150:complications
chemical_list: D000962:Antimalarials; D015767:Mefloquine