MALARIA CHEMOTHERAPY TRIAL AT A MINIMAL EFFECTIVE DOSE OF MEFLOQUINE SULFADOXINE/PYRIMETHAMINE COMPARED WITH EQUIVALENT DOSES OF SULFADOXINE/PYRIMETHAMINE OR MEFLOQUINE ALONE/

In murine malaria the addition of mefloquine to sulfadoxine/pyrimetham ine has been shown to exert an additive effect and to significantly sl ow the emergence of resistance to the individual components. In a pilo t study carried out in Gabon, a reduced dosage of the triple combinati on with a mean of 1 mg/kg of mefloquine/2 mg/kg of sulfadoxine/0.1 mg/ kg of pyrimethamine (Fansimef(R); Roche, Basel, Switzerland) had previ ously been shown to achieve high cure rates in Plasmodium falciparum m alaria. To evaluate the additive effect, a randomized, double-blind tr ial in school children with mild P. falciparum malaria was performed i n Gabon. Two hundred thirty-one patients evaluated received a single d ose of either the triple combination with a mean of 1.07 mg/kg of mefl oquine/2.14 mg/kg of sulfadoxine/0.11 mg/kg of pyrimethamine (group MS P), or 1.07 mg/kg of mefloquine alone (group M), or 2.14 mg/kg of sulf adoxine/0.11 mg/kg of pyrimethamine alone (group SP). In the MSP group and the SP group, 67% and 69% of the patients were parasitologically cured, respectively, compared with only 13% in the M group (P < 0.001) . A significantly higher parasitemia was found in the M group compared with the MSP group or the SP group on days 2 and 3 after the start of treatment. The high efficacy of the low dose sulfadoxine/pyrimethamin e regimen was the most surprising finding of this study.