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Title: Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria
Authors: R. N. Price
F. Nosten
C. Luxemburger
M. Van Vugt
L. Phaipun
T. Chongsuphajaisiddhi
N. J. White
Shoklo Malaria Research Unit
St George's University of London
Mahidol University
Academic Medical Centre, University of Amsterdam
John Radcliffe Hospital
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Jan-1997
Citation: Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.91, No.5 (1997), 574-577
Abstract: 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 > 40,000/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 1.3-7) 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.
ISSN: 00359203
Appears in Collections:Scopus 1991-2000

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