Treating a uncomplicated form of Plasmodium falciparum malaria.

In 1997 in France, 95% of the malaria cases were uncomplicated, according t o the WHO's definition. Choosing an early treatment depends on Plasmodium f alciparum resistance (80% of malaria is due to Plasmodium species), case hi story, parasitemia level, type of chemoprophylaxis, drug cost, antimalarial tolerance, and compliance. Except for cardiac contraindications, the first -line treatment is halofantrine, which is better tolerated than mefloquine. Electrocardiogram examination is mandatory before halofantrine is prescrib ed. A history of psychiatric and convulsive disorders contraindicates meflo quine use. Chloroquine is now rarely used in France. Pyrimethamine-sulfadox ine is hardly ever used because of its side effects and increasing resistan ce. In the event of contraindication or clinical parasitological resistance of mefloquine or halofantrine, quinine is used with particular attention t o the continuation of mefloquine after the quinine treatment. New resistanc e to quinine in the Southeast Asian border areas and in Amazonia justifies using quinine + doxycycline for cases imported from these areas. Artemether is not indicated except for proven quinine resistance. For children under two years of age and pregnant women, mefloquine and halofantrine contraindi cation is only relative. Quinine is the least expensive antimalarial drug. Compliance is best with halofantrine. The mean hospital stay is four days i n France but hospitalization is not necessary if an examination of patients at days three and seven is possible. It is preferable to prescribe only a half dose of halofantrine at day seven. The parasitemia level and electroca rdiogram are the main complementary examinations; thrombopenia is more a sy mptom than a sign of severity. (C) 1999 Editions scientifiques et medicales Elsevier SAS.