Michèle Van VugtElisabetta LeonardiLucy PhaipunThra SlightKyaw Lay ThwayRose McGreadyAlan BrockmanLeopoldo VillegasSornchai LooareesuwanNicholas J. WhiteFranc̃ois NostenShoklo Malaria Research UnitMahidol UniversitySlotervaart HospitalJohn Radcliffe Hospital2018-07-242018-07-242002-12-15Clinical Infectious Diseases. Vol.35, No.12 (2002), 1498-1504105848382-s2.0-0037115248https://repository.li.mahidol.ac.th/handle/20.500.14594/20175In an open-label trial carried out on the northwest border of Thailand, 1596 patients with uncomplicated multidrug-resistant falciparum malaria were randomly assigned to receive atovaquone-proguanil, atovaquone-proguanil-artesunate, or artesunate-mefloquine and were followed up for 42 days. All 3 regimens were highly effective and well tolerated. Fever duration and parasite clearance times were significantly shorter among patients who received artesunate (P < .001). Polymerase chain reaction genotyping confirmed that recrudescence occurred in 13 patients who received artesunate-mefloquine (2.4%), 5 who received atovaquone-proguanil-artesunate (0.9%), and 15 who received atovaquone-proguanil (2.8%). Adding artesunate to atovaquone-proguanil reduced the risk of failure 3-fold (95% confidence interval [CI], 1.1-8.2) and subsequent gametocyte carriage 21-fold (95% CI, 14-30). Gastrointestinal complaints in the first 48 h after initiation of treatment were more common among artesunate recipients, but after day 2, dizziness, sleep disturbance, nausea, vomiting, and anorexia were more common among mefloquine recipients (P ≤ .014). Artesunate-atovaquone-proguanil is a highly effective and well-tolerated treatment for multidrug-resistant falciparum malaria.Mahidol UniversityImmunology and MicrobiologyArticleSCOPUS10.1086/344901