Treatment of multidrug-resistant Plasmodium falciparum malaria with 3-day artesunate-mefloquine combination

J Infect Dis. 1994 Oct;170(4):971-7. doi: 10.1093/infdis/170.4.971.

Abstract

Studies of 652 adults and children with acute uncomplicated falciparum malaria were done to determine the optimum treatment of multidrug-resistant Plasmodium falciparum malaria on the Thai-Burmese border. Single-dose artesunate (4 mg/kg) plus mefloquine (25 mg of base/kg) gave more rapid symptomatic and parasitologic responses than high-dose mefloquine alone but did not improve cure rates. Three days of artesunate (total dose, 10 mg/kg) plus mefloquine was 98% effective compared with a 28-day failure rate of 31% with high-dose mefloquine alone (relative risk [RR], 0.06; 95% confidence interval [CI], 0.02-0.2; P < .0001). By day 63, the reinfection adjusted failure rates were 2% and 44%, respectively (P < .0001). Artesunate also prevented high-grade failures. Both drugs were well tolerated. No adverse effects were attributable to artesunate. Vomiting was reduced significantly by giving mefloquine on day 2 of treatment (RR, 0.40; 95% CI, 0.20-0.79; P = .009. Artesunate (10 mg/kg over 3 days) plus mefloquine (25 mg/kg) is currently the most effective treatment for falciparum malaria in this area of increasing mefloquine resistance.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Antimalarials / therapeutic use*
  • Artemisinins*
  • Artesunate
  • Child
  • Disease-Free Survival
  • Drug Administration Schedule
  • Drug Resistance, Multiple*
  • Drug Therapy, Combination
  • Follow-Up Studies
  • Humans
  • Malaria, Falciparum / drug therapy*
  • Mefloquine / therapeutic use*
  • Myanmar
  • Plasmodium falciparum / drug effects
  • Recurrence
  • Sesquiterpenes / therapeutic use*
  • Thailand
  • Time Factors

Substances

  • Antimalarials
  • Artemisinins
  • Sesquiterpenes
  • Artesunate
  • Mefloquine