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Title: Optimising operational use of artesunate-mefloquine: A randomised comparison of four treatment regimens
Authors: Frank Smithuis
Ingrid van der Broek
Nina Katterman
Moe Kyaw Kyaw
Alan Brockman
Saw Lwin
Nicholas J. White
Medecins sans Frontieres
Mahidol University
John Radcliffe Hospital
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Mar-2004
Citation: Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.98, No.3 (2004), 182-192
Abstract: A randomised trial was conducted in adults and children (>1 year old) with acute falciparum malaria in Western Myanmar to compare the operational effectiveness of 4 different artesunate-mefloquine combinations. All regimens were well tolerated. During 42 days follow-up polymerase chain reaction genotyping-confirmed recrudescence occurred in 11 of 187 (5.9%) patients who received observed single low-dose mefloquine (15 mg/kg) and artesunate (4 mg/kg), 7 of 192 (3.6%) patients following observed single high-dose mefloquine (25 mg/kg) and artesunate (4 mg/kg), 7 of 180 (3.9%) patients following observed artesunate 4 HSP mg/kg on day 0 plus self-administered mefloquine 15 mg/kg on day 1 and 10 mg/kg on day 2 with artesunate 4 mg/kg/day on day 1 and 2 , and none of 177 patients who received this 3 d regimen under direct observation (P=0.01). Compared with 3 d treatment regimens, single dose treatments were followed by significantly more P vivax infections during the 42 d follow-up (P=0.009). Post treatment anaemia (haemoglobin <10 g/dL) was reduced by the 3 d regimens. Gametocyte appearance was low with all 4 regimens. Single dose observed mefloquine-artesunate regimens were very effective, but the 3 d artesunate-mefloquine regimen is the best treatment for acute falciparum malaria in Western Myanmar. Active measures to ensure absorption and improve adherence will be necessary to realise this advantage operationally. © 2003 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
ISSN: 00359203
Appears in Collections:Scopus 2001-2005

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