COMPARATIVE CLINICAL-TRIAL OF ARTESUNATE FOLLOWED BY MEFLOQUINE IN THE TREATMENT OF ACUTE UNCOMPLICATED FALCIPARUM-MALARIA - 2-DAY AND 3-DAY REGIMENS

The difficulties in treating drug-resistant falciparum malaria in Thai land are compounded by the necessity of giving antimalarials over long periods of time, The resultant decrease in patient compliance not onl y lowers cure rates but also predisposes to the further spread of drug resistance. We compared the efficacy of two sequential treatment regi mens given over two and three days in 111 patients with acute uncompli cated falciparum malaria. Sixty-seven patients received two 400-mg dos es of artesunate (total dose = 800 mg) followed by two doses of mefloq uine (750 mg given immediately and 500 mg 12 hr later; total dose = 1, 250 mg) in Group I. Forty-four patients (Group II) received four 200-m g doses of artesunate (total dose = 800 mg) given 12 hr apart followed by a mefloquine regimen similar to that for Group I. All patients wer e admitted to hospital in Bangkok for 28 days to preclude reinfection. Ninety-six patients completed the study. Cure rates for the two group s were 84% (49 of 58) for Group I and 100% (38 of 38) for Group II. Th e mean parasite clearance time and fever clearance time were significa ntly shorter in Group II (P < 0.02), There were no serious adverse rea ctions. All nine of the treatment failures in Group I were of the RI t ype. The results indicate that the sequential treatment with artesunat e followed by mefloquine given over three days is effective and well-t olerated in patients with acute, uncomplicated falciparum malaria and suitable as an alternative treatment for multidrug-resistant falciparu m malaria.