title: Comparative study of the effectiveness and pharmacokinetics of two rectal artesunate/oral mefloquine combination regimens for the treatment of uncomplicated childhood falciparum malaria.
abstract: BACKGROUND
  Rectal artesunate has been shown to be an effective treatment for falciparum malaria and is useful in patients who cannot take medicine orally or when parenteral medication is inconvenient. A combination with mefloquine can decrease the duration of treatment, increase compliance and delay development of resistance. There are no clear data on whether a higher dosage of rectal artesunate results in a better clinical response.
  
  
  OBJECTIVE
  To assess two rectal artesunate/oral mefloquine regimens for treating uncomplicated multi-drug-resistant childhood falciparum malaria.
  
  
  METHODS
  Seventy children aged 1-14 years with uncomplicated falciparum malaria were randomly assigned to receive either 10 (range 8-12) or 20 (range 16-24) mg/kg/day rectal artesunate for 3 days followed by 25 mg/kg oral mefloquine. The study endpoints were fever clearance time, parasite clearance time and proportion of patients with recrudescence. Serum levels of artesunate and dihydro-artemisinin were measured after the first dose of rectal artesunate in 16 subjects.
  
  
  RESULTS
  Both regimens were safe and effective. The cure rate was 100% in the 53 patients who completed 28-day follow-up. All of the study endpoints were comparable between both treatment groups.
  
  
  CONCLUSIONS
  A regimen of rectal artesunate 10 mg/kg/day for 3 days followed by mefloquine 25 mg/kg is optimal for the treatment of uncomplicated falciparum malaria. There was no definite benefit from increasing the dosage of rectal artesunate from 10 to 20 mg/kg/day.
authors.affiliation: Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, 420/6 Rachawithi Road, Bangkok 10400, Thailand. tmcsw@mahidol.ac.th
authors.forename: Chukiat
authors.initials: C
authors.lastname: Sirivichayakul
authors.forename: Arunee
authors.initials: A
authors.lastname: Sabchareon
authors.forename: Krisana
authors.initials: K
authors.lastname: Pengsaa
authors.forename: Itthipon
authors.initials: I
authors.lastname: Thaiarporn
authors.forename: Anong
authors.initials: A
authors.lastname: Chaivisuth
authors.forename: Kesara
authors.initials: K
authors.lastname: Na-Bangchang
authors.forename: Pataraporn
authors.initials: P
authors.lastname: Wisetsing
authors.forename: Pornthep
authors.initials: P
authors.lastname: Chanthavanich
authors.forename: Chanathep
authors.initials: C
authors.lastname: Pojjaroen-Anant
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000293:Adolescent; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D000077332:Artesunate; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine