Publication: The neurological assessment in young children treated with artesunate monotherapy or artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria
Accepted Date
2009-09-02
Issued Date
2009
Resource Type
Language
eng
ISSN
1475-2875 (electronic)
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Mahidol University
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BioMed Central
Bibliographic Citation
Ambler MT, Dubowitz LM, Arunjerdja R, Hla EP, Thwai KL, Viladpainguen J, et al. The neurological assessment in young children treated with artesunate monotherapy or artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria. Malar J 2009 Sep 2;8:207.
Suggested Citation
Ambler, Michael T., Dubowitz, Lilly M., Ratree Arunjerdja, Hla, Eh Paw, Thwai, Kyaw Lay, Viladpainguen, Jacher, Pratap Singhasivanon, ประตาป สิงหศิวานนท์, uxemburger, Christine, Nosten, François, McGready, Rose The neurological assessment in young children treated with artesunate monotherapy or artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria. Ambler MT, Dubowitz LM, Arunjerdja R, Hla EP, Thwai KL, Viladpainguen J, et al. The neurological assessment in young children treated with artesunate monotherapy or artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria. Malar J 2009 Sep 2;8:207.. doi:10.1186/1475-2875-8-207 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/643
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Title
The neurological assessment in young children treated with artesunate monotherapy or artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria
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Abstract
Background: Mefloquine and artesunate combination therapy is the recommended first-line treatment for uncomplicated malaria throughout much of south-east Asia. Concerns have been raised about the potential central
nervous system (CNS) effects of both drug components and there are no detailed reports in very young children.
Methods: Children, aged between three months and five years, with acute uncomplicated Plasmodium falciparum malaria
were randomized to either 7 days of artesunate monotherapy or the same schedule of artesunate plus mefloquine on
day 7 and 8. Neurological testing targeting coordination and behaviour was carried out at day 0, 7, 9, 10, 14 and 28. Nonfebrile
healthy control children from the same population were tested on days 0, 7, 14 and 28.
Results: From December 1994 to July 1997, 91 children with uncomplicated P. falciparum, 45 treated with artesunate
monotherapy, 46 treated with mefloquine and artesunate combination therapy and 36 non-febrile controls, underwent
neurological testing. Malaria and fever had a significant negative impact on testing performance. By contrast, the antimalarial
treatments were not associated with worsening performances in the various components of the test. Artesunate
and mefloquine do not appear to have a significant influence on coordination and behaviour. Children treated with
mefloquine were significantly less likely to suffer recurrent malaria infection during follow-up compared to those treated
with artesunate alone (P = 0.033).
Conclusion: In keeping with the results of randomized controlled trials in adults, mefloquine was not associated with a
decrease in specific items of neurological performance. Likewise, children treated with artesunate did not perform
significantly differently to control children. This study does not exclude subtle or rare treatment CNS effects of
artesunate or mefloquine. Treatment of acute uncomplicated malaria results in a significant improvement on items of
neurological performance.