EFFICACY AND TOLERANCE OF ARTEMISININ IN SHORT COMBINATION REGIMENS FOR THE TREATMENT OF UNCOMPLICATED FALCIPARUM-MALARIA

Two oral regimens comprising a single dose of 20 mg/kg of artemisinin followed by three days of quinine, 10 mg/kg three times a day (AQ), or doxycycline, 4 mg/kg once a day (AD), were compared with a standard s even-day course of oral quinine, 10 mg/kg three times a day (Q), in th e treatment of uncomplicated falciparum malaria. Of 161 treated patien ts, 157 could be included in the analysis. The mean +/-SD parasite cle arance time was 43 +/- 14 hr for AQ and 41 +/- 19 hr for AD, and signi ficantly longer for quinine: 66 +/- 14 hr (P = 0.0001). Treatment fail ure occurred in one Q and in 3 AD patients. The recrudescence rate was 16% for Q, 28% for AQ, and significantly worse for AD: 67% (P = 0.000 1). Adverse effects were mainly limited to cinchonism. The conclusion is that a seven-day course of quinine is still effective in the initia l treatment of uncomplicated falciparum malaria in Vietnam, but one sh ould pay attention to possible recrudescence. The addition of a single 20 mg/kg per os dose of artemisinin allows for shortening the duratio n of treatment, with faster parasite clearance, comparable efficacy, a nd better tolerance, but with no reduction of recrudescence. The combi nation of artemisinin with three days of doxycycline is also not effec tive in preventing recrudescence.