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|Title:||Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria|
|Authors:||R. N. Price|
M. Van Vugt
N. J. White
Shoklo Malaria Research Unit
St George's University of London
Academic Medical Centre, University of Amsterdam
John Radcliffe Hospital
|Keywords:||Immunology and Microbiology;Medicine|
|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.|
|Appears in Collections:||Scopus 1991-2000|
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