SINGLE-DOSE ARTEMISININ MEFLOQUINE TREATMENT FOR ACUTE UNCOMPLICATED FALCIPARUM-MALARIA

For the treatment of patients with acute falciparum malaria, the combi nation of artemisinin as a single dose with a single dose of mefloquin e was studied in 4 separate prospective trials, comprising 405 adults and 139 children with uncomplicated falciparum malaria in 2 in-patient and 2 rural out-patient studies in Viet Nam. Adults received oral art emisinin and children artemisinin suppositories. Randomized comparativ e treatment schedules were: artemisinin alone for 5 d, mefloquine-sulf adoxine-pyrimethamine (MSP), or quinine plus sulfadoxine-pyrimethamine (SP). Parasite clearance times (PCT) were rapid for artemisinin treat ed inpatients (90%: 14.8-20.4 h) but also for patients receiving MSP ( PCT 90%: 18.0 h) and quinine (PCT 90%: 22.5 h). The recrudescence rate (RI) during a 28 d follow-up period among the patients given artemisi nin plus mefloquine was 15% in the adult in-patients and zero in the a dult and children out-patients. RI in the artemisinin 5 d treatment gr oup was 33.3%; among those given artemisinin plus SP it was 47.3% in i npatients and in out-patients 46.1%. In the MSP treated out-patients R I was 1.5% in adults and zero in children. Artemisinin as a single dos e (oral in adults and as a suppository in children) in combination wit h mefloquine was effective in rapidly lowering parasitaemia and in pre venting recrudescence in hospital inpatients and in out-patients atten ding a rural health clinic. MSP alone as a single dose also rapidly re duced parasitaemia (but not as quickly as the artemisinin-mefloquine c ombination in out-patient children) and prevented recrudescence.