Publication: Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria
Issued Date
1997-01-01
Resource Type
ISSN
00359203
Other identifier(s)
2-s2.0-0030662494
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Mahidol University
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SCOPUS
Bibliographic Citation
Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.91, No.5 (1997), 574-577
Suggested Citation
R. N. Price, F. Nosten, C. Luxemburger, M. Van Vugt, L. Phaipun, T. Chongsuphajaisiddhi, N. J. White Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.91, No.5 (1997), 574-577. doi:10.1016/S0035-9203(97)90032-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/18008
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Title
Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria
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.