F. Nosten et al., TREATMENT OF MULTIDRUG-RESISTANT PLASMODIUM-FALCIPARUM MALARIA WITH 3-DAY ARTESUNATE MEFLOQUINE COMBINATION, The Journal of infectious diseases, 170(4), 1994, pp. 971-977
Studies of 652 adults and children with acute uncomplicated falciparum
malaria were done to determine the optimum treatment of multidrug-res
istant Plasmodium falciparum malaria on the Thai-Burmese border. Singl
e-dose artesunate (4 mg/kg) plus mefloquine (25 mg of base/kg) gave mo
re rapid symptomatic and parasitologic responses than high-dose mefloq
uine alone but did not improve cure rates. Three days of artesunate (t
otal dose, 10 mg/kg) plus mefloquine was 98% effective compared with a
28-day failure rate of 31% with high-dose mefloquine alone (relative
risk [RR], 0.06; 95% confidence interval [CI], 0.02-0.2; P <.0001). By
day 63, the reinfection adjusted failure rates were 2% and 44%, respe
ctively (P <.0001). Artesunate also prevented high-grade failures. Bot
h drugs were well tolerated. No adverse effects were attributable to a
rtesunate. Vomiting was reduced significantly by giving mefloquine on
day 2 of treatment (RR, 0.40; 95% CI, 0.20-0.79; P =.009. Artesunate (
10 mg/kg over 3 days) plus mefloquine (25 mg/kg) is currently the most
effective treatment for falciparum malaria in this area of increasing
mefloquine resistance.