title: Mefloquine treatment for uncomplicated falciparum malaria in young children 6-24 months of age in northern Ghana.
abstract: Mefloquine (MQ) single dose 20 mg/kg treatment of falciparum malaria was evaluated in 186 children of 6-24 months of age in northern Ghana. There were 15 RII/RIII-type parasitologic failures, all with Day 2 MQ blood levels significantly lower than children whose parasitemias cleared before Day 7 and remained clear through 28 days. Predictors of RII/RIII parasitologic response were vomiting after MQ dosing, Day 2 MQ levels < 500 ng/mL, and undetectable Day 2 levels of the carboxymefloquine metabolite. There were 50 cases of delayed RI parasitologic failure, but 71% of these cases had undetectable Day 28 blood levels of MQ and drug levels in the remaining 29% ranged below the 620 ng/mL level that suppresses MQ sensitive strains of P. falciparum. Drug levels among infants that tolerated MQ well were not associated with age, weight, hemoglobin, parasitemia, and pre-existing symptoms of vomiting or diarrhea. An observed recurrent parasitemia of 34,400 trophozoites/microL against a MQ blood concentration of 550 ng/mL was taken as indication of tolerance to suppressive levels of the drug at this location.
authors.affiliation: US Naval Medical Research Unit No. 3, Cairo, Egypt. fryauffd@umrc.navy.mil
authors.forename: David J
authors.initials: DJ
authors.lastname: Fryauff
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Gregory
authors.initials: G
authors.lastname: Utz
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Baird
authors.forename: Kwadwo A
authors.initials: KA
authors.lastname: Koram
authors.forename: Fred
authors.initials: F
authors.lastname: Binka
authors.forename: Francis
authors.initials: F
authors.lastname: Nkrumah
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Hoffman
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D005869:Ghana; D006801:Humans; D007223:Infant; D016014:Linear Models; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D015767:Mefloquine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D018512:Parasitemia / Q000188:drug therapy; D010963:Plasmodium falciparum / Q000254:growth & development*; D011446:Prospective Studies; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000962:Antimalarials; D015767:Mefloquine