title: Optimising operational use of artesunate-mefloquine: a randomised comparison of four treatment regimens.
abstract: A randomised trial was conducted in adults and children (> 1 year old) with acute falciparum malaria in Western Myanmar to compare the operational effectiveness of 4 different artesunate-mefloquine combinations. All regimens were well tolerated. During 42 days follow-up polymerase chain reaction genotyping-confirmed recrudescence occurred in 11 of 187 (5.9%) patients who received observed single low-dose mefloquine (15 mg/kg) and artesunate (4 mg/kg), 7 of 192 (3.6%) patients following observed single high-dose mefloquine (25 mg/kg) and artesunate (4 mg/kg), 7 of 180 (3.9%) patients following observed artesunate 4 mg/kg on day 0 plus self-administered mefloquine 15 mg/kg on day 1 and 10 mg/kg on day 2 with artesunate 4 mg/kg/day on day 1 and 2, and none of 177 patients who received this 3 d regimen under direct observation (P = 0.01). Compared with 3 d treatment regimens, single dose treatments were followed by significantly more P vivax infections during the 42 d follow-up (P = 0.009). Post treatment anaemia (haemoglobin < 10 g/dL) was reduced by the 3 d regimens. Gametocyte appearance was low with all 4 regimens. Single dose observed mefloquine-artesunate regimens were very effective, but the 3 d artesunate-mefloquine regimen is the best treatment for acute falciparum malaria in Western Myanmar. Active measures to ensure absorption and improve adherence will be necessary to realise this advantage operationally.
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand.
authors.forename: Frank
authors.initials: F
authors.lastname: Smithuis
authors.forename: Ingrid
authors.initials: I
authors.lastname: van der Broek
authors.forename: Nina
authors.initials: N
authors.lastname: Katterman
authors.forename: Moe Kyaw
authors.initials: MK
authors.lastname: Kyaw
authors.forename: Alan
authors.initials: A
authors.lastname: Brockman
authors.forename: Saw
authors.initials: S
authors.lastname: Lwin
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000469:parasitology; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000188:drug therapy*; D016780:Malaria, Vivax / Q000188:drug therapy; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D012423:Rural Health; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D006454:Hemoglobins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine