Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 1997-09, Vol.91 (5), p.574-577
• Main Authors: Price, R.N., Nosten, F., Luxemburger, C., van Vugt, M., Phaipun, L., Chongsuphajaisiddhi, T., White, N.J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials - adverse effects; Antimalarials - therapeutic use; Antiparasitic agents; Artemisinins; Artesunate; Biological and medical sciences; chemotherapy; Child; Child, Preschool; Drug Resistance, Multiple; Drug Therapy, Combination; Endemic Diseases; Female; Fever - drug therapy; Follow-Up Studies; Human protozoal diseases; Humans; Infant; Infectious diseases; Malaria; Malaria, Falciparum - drug therapy; Male; Medical sciences; mefloquine; Mefloquine - adverse effects; Mefloquine - therapeutic use; Middle Aged; Parasitemia - drug therapy; Parasitic diseases; Pharmacology. Drug treatments; Plasmodium falciparum; Prospective Studies; Protozoal diseases; Recurrence; Risk Factors; Sesquiterpenes - adverse effects; Sesquiterpenes - therapeutic use; Thailand; Treatment Outcome; Tropical medicine
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/S0035-9203(97)90032-8

On the western border of Thailand, in an area endemic for multi-drug resistant Plasmodium falciparum malaria, therapeutic responses were assessed in 1967 patients with uncomplicated falciparum malaria treated with 3 d of artesunate (total dose 12 mg/kg) plus mefloquine (total dose 25 mg/kg).The regimen was well tolerated and resulted in a rapid clinical response; within 48 h, 96% of patients were aparasitaemic and 94% were afebrile. After correcting for reinfections, the cure rate by day 42 was 89% (95% confidence interval [95% CI] 87–91%).Three independent factors were found to predict recrudescence: age < 14 years (adjusted hazards ratio [AHR] = 1·6, 95% CI 1·1–2·3), initial parasitaemia greater than > 40000/μL (AHR = 1·6, 95% CI 1·2–2·2), and pure P. falciparum infections (AHR = 1·8, 95% CI 1·3–2·7). These 3 factors combined accounted for 62% of all treatment failures. Patients who received mefloquine on admission with a high admission parasitaemia (> 40 000/μL) had a three-fold (95% CI 1μ3–7) risk of subsequent recrudescence compared with those who received their mefloquine on the second or third day ( P = 0·01). There has been no decline in the efficacy of the 3 d artesunate plus mefloquine regimen since it was introduced in 1992. This regimen is safe, well tolerated, and highly effective in the treatment of multi-drug resistant falciparum malaria.