title: Mefloquine for uncomplicated Plasmodium falciparum malaria in children.
abstract: BACKGROUND
  Children with uncomplicated Plasmodium falciparum imported malaria are treated with various antimalarial regimens including mefloquine depending on national guidelines. Little is known regarding mefloquine treatment efficacy in this setting.
  
  
  METHODS
  In this prospective study, children 3 months to 16 years of age admitted in a tertiary hospital emergency ward in France with uncomplicated P. falciparum malaria were treated with oral mefloquine. Each dose was given with an antiemetic.
  
  
  RESULTS
  Between 2004 and 2009, 95 children were evaluated. In all, 94% had traveled in the Indian Ocean region (Comoros and Madagascar); 79% used a malaria chemoprophylaxis, but none was fully compliant with World Health Organization recommended regimens. Main clinical features at admission were fever (91%), vomiting (44%), and headaches (44%). Hemoglobin < 80 g/L and platelets <100 G/L were observed in 16% and 17%, respectively. All children were initially cured by mefloquine, and no relapse was noted within 45 days after admission. One Plasmodium vivax relapse occurred 6 months later. Vomiting within 1 hour after dosing occurred in 20% of children. Significant features associated with early vomiting by univariate analysis were a weight ≤ 15 kg, C-reactive protein ≥ 50 mg/L, and parasitemia ≥ 1%, but only low weight was significant by multivariate analysis.
  
  
  CONCLUSIONS
  Mefloquine is an effective treatment for uncomplicated imported P. falciparum malaria in children returning from countries with low mefloquine resistance. Early vomiting after mefloquine dosing is frequent, especially in children < 15 kg of weight, but a second dose can be given successfully.
authors: Pediatric Emergency, CHU Nord, Chemin des Bourrelly, Marseille Cedex, France. philippe.minodier@ap-hm.fr
authors: Philippe
authors: P
authors: Minodier
authors: Guilhem
authors: G
authors: Noël
authors: Mamadou
authors: M
authors: Tall
authors: Karine
authors: K
authors: Retornaz
authors: Renaud
authors: R
authors: Piarroux
authors: Daniel
authors: D
authors: Parzy
authors: Stephane
authors: S
authors: Ranque