[Therapeutic efficacy of a regimen of artesunate-mefloquine-primaquine treatment for Plasmodium falciparum malaria and treatment effects on gametocytic development].
BACKGROUND
The treatment of Plasmodium falciparum malaria requires a safe and effective therapeutic treatment regimen, which in turn has high impact on the transmission. In 2006, an artesunate (AS)-mefloquine (MQ) treatment program was implemented in Antioquia. In addition, primaquine (PQ) was added to eliminate malaria gametocytes in the bloodstream.


OBJECTIVE
The efficacy and gametocytocidal activity was evaluated for two treatment regimens, AS-MQ-PQ and AS-MQ, in patients with uncomplicated P. falciparum malaria.


METHODS
Between April 2007 and February 2008, 50 patients were recruited for the trial in Turbo, Antioquia. A randomized clinical trial was conducted. Treatment compliance was supervised, with a clinical and parasitological assessment on days 1, 2, 3, 7, 14, 21, 28, 35, and 42 to evaluate response rate according to the WHO 2003 protocol.


RESULTS
Clinical response and parasite elimination efficacy of AS-MQ (with or without PQ) was 100% (95% CI 86.3%-100%), and parasitemia and fever were absent on day 3 of treatment in all patients. Gametocyte elimination was superior when PQ was used--92% (95% CI: 74%-99%) of patients who received PQ had no gametocytes on day 3, compared to 78.3% (95% CI: 59%-93%) of patients who only received AS-MQ. Furthermore, circulating gametocytes were eliminated on average one week faster when the AS-MQ-PQ treatment scheme was used compared to the scheme without PQ.


CONCLUSIONS
These studies recommend the use of AS-MQ to treat P. falciparum malaria given its good therapeutic efficacy. However, further assessment is suggested concerning the benefit of adding PQ to this treatment scheme.
Grupo de Malaria, Universidad de Antioquia, Medellín, Colombia. amvc.ana@gmail.com
Ana María
AM
Vásquez
Felipe
F
Sanín
Luís Gonzalo
LG
Alvarez
Alberto
A
Tobón
Alexandra
A
Ríos
Silvia
S
Blair
D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000077332:Artesunate; D002648:Child; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000209:etiology; D005854:Germ Cells / Q000187:drug effects*; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D018512:Parasitemia / Q000188:drug therapy* / Q000469:parasitology; D010349:Patient Compliance; D010865:Pilot Projects; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000254:growth & development; D011319:Primaquine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D011319:Primaquine; D015767:Mefloquine