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Trung, T.N. et al.

Treatment of falciparum malaria in Vietnamese children: the need for combination therapy and optimized dosage regimens.

To assess the in vivo sensitivity of Plasmodium falciparum to mefloquine and artesunate in a hyperendemic area of southern Viet Nam, we studied 41 children and 21 adults from a remote commune who had uncomplicated falciparum malaria without previous treatment. Patients were randomly allocated to artesunate (4 mg/kg on day 0 and 2 mg/kg on days 1-4) or mefloquine (10 mg/kg followed by 5 mg/kg at 6 h). Serial assessments were performed over 28 days. Of 31 patients allocated artesunate, nine (29%) redeveloped parasitaemia during follow-up compared with 23% (seven of 30) who received mefloquine. Of the 41 children, 15 (37%) had recrudescence/re-infection compared with only one of 20 adults (5%; p < 0.001). Significantly more children than adults failed on mefloquine treatment (37% vs 0%; p = 0.021) and one case showed RIII resistance. There was no significant difference in the case of artesunate. In regression analysis, parasitaemia was an independent predictor of recrudescence/re-infection after mefloquine (p = 0.02). These data support the use of combination therapy such as artesunate plus mefloquine for falciparum malaria in a hyperendemic area of Viet Nam. Primarily because of their greater parasite densities, children should be given higher doses of mefloquine (e.g. 25 mg/kg).[1]

References

Treatment of falciparum malaria in Vietnamese children: the need for combination therapy and optimized dosage regimens. Trung, T.N., Davis, T.M., Hewitt, S., Thuan, L.K., Quang, H.H., Anh, C.V., Thuy, P.T., Thoa, N.T., Tuan, N.T., Hang, N.T., Giang, L.T. Annals of tropical paediatrics. (2001) [Pubmed]

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