ARTESUNATE VERSUS ARTEMETHER IN COMBINATION WITH MEFLOQUINE FOR THE TREATMENT OF MULTIDRUG-RESISTANT FALCIPARUM-MALARIA

To compare the therapeutic efficacy of oral artesunate and artemether in combination with mefloquine for the treatment of mutidrug resistant malaria, a trial was conducted in 540 adults and children on the Thai -Myanmar border. Three regimens were compared: artesunate (4 mg/kg/d f or 3 d), artemether (4 mg/kg/d for 3 d), both in combination with mefl oquine (25 mg/kg), and a single dose of mefloquine (25 mg/kg). The art esunate and artemether regimens gave very similar clinical and parasit ological responses, and were both very well tolerated. There was no si gnificant adverse effect attributable to the artemisinin derivatives. Fever and parasite clearance times with mefloquine alone were signific antly longer (P < 0.001). After adjusting for reinfections the failure rates were 13.9% for the artesunate combination, 12.3% for the arteme ther combination and 49.2% for mefloquine alone (P < 0.0001; relative risk 3.8 [95% confidence interval 2.6-5.4]). Mefloquine should no long er be used alone for the treatment of multidrug resistant falciparum m alaria in this area. Three-day combination regimens with artesunate or artemether are well tolerated and more effective.