Treatment of falciparum malaria in Vietnamese children: the need for combination therapy and optimized dosage regimens.
To assess the in vivo sensitivity of Plasmodium falciparum to mefloquine and artesunate in a hyperendemic area of southern Viet Nam, we studied 41 children and 21 adults from a remote commune who had uncomplicated falciparum malaria without previous treatment. Patients were randomly allocated to artesunate (4 mg/kg on day 0 and 2 mg/kg on days 1-4) or mefloquine (10 mg/kg followed by 5 mg/kg at 6 h). Serial assessments were performed over 28 days. Of 31 patients allocated artesunate, nine (29%) redeveloped parasitaemia during follow-up compared with 23% (seven of 30) who received mefloquine. Of the 41 children, 15 (37%) had recrudescence/re-infection compared with only one of 20 adults (5%; p < 0.001). Significantly more children than adults failed on mefloquine treatment (37% vs 0%; p = 0.021) and one case showed RIII resistance. There was no significant difference in the case of artesunate. In regression analysis, parasitaemia was an independent predictor of recrudescence/re-infection after mefloquine (p = 0.02). These data support the use of combination therapy such as artesunate plus mefloquine for falciparum malaria in a hyperendemic area of Viet Nam. Primarily because of their greater parasite densities, children should be given higher doses of mefloquine (e.g. 25 mg/kg).
Trung
T N
TN
Institute of Malariology, Parasitology and Entomology, Quy Nhon City, Binh Dinh Province, Viet Nam.
Davis
T M
TM
Hewitt
S
S
Thuan
L K
LK
Quang
H H
HH
Anh
C V
CV
Thuy
P T
PT
Thoa
N T
NT
Tuan
N T
NT
Hang
N T
NT
Giang
L T
LT
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D023801:Directly Observed Therapy; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D016014:Linear Models; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*; D018512:Parasitemia / Q000188:drug therapy; D021261:Parasitic Sensitivity Tests; D012008:Recurrence; D012044:Regression Analysis; D012717:Sesquiterpenes / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D014744:Vietnam / Q000453:epidemiology
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine