ARTEMETHER-MEFLOQUINE COMBINATION IN MULTIDRUG-RESISTANT FALCIPARUM-MALARIA

Plasmodium falciparum in Thailand is highly resistant to chloroquine a nd sulfadoxine/pyrimethamine and there is increasing resistance to the alternative antimalarials, quinine and mefloquine. In eastern Thailan d, the cure rates of mefloquine at 750 and 1250 mg were 30% and 55%, r espectively. The use of drug combinations may be necessary in areas wh ere drug-resistant parasites exist. 159 male Thai patients in Chantabu ri, eastern Thailand, were allocated at random to receive either oral artemether at a single dose of 300 mg on the first day followed by mef loquine 750 mg at 24 h and 500 mg at 30 h (group A), or oral artemethe r at a single dose of 300 mg on the first day, mefloquine 750 mg at 24 h and placebo at 30 h (group B). The followup was on days 1, 2, 7, 14 , 21, 28, 35 and 42. Most patients in both groups had a rapid initial response to treatment, parasitaemia being cleared within 24 h and feve r cleared within 48 h in both groups. The cure rates were 97% and 90%, respectively, for groups A and B. No serious adverse effect was seen in either group; mild and transient nausea, vomiting and loss of appet ite were noted. The adverse effects did not differ between the 2 group s. The results suggested that a single oral dose of artemether (300 mg ) can markedly improve the cure rate of mefloquine at a dose of 750 or 1250 mg in multiple drug-resistant falciparum malaria.