A Randomized Trial of Artesunate-Mefloquine versus Artemether-Lumefantrine for Treatment of Uncomplicated Plasmodium falciparum Malaria in Mali

• Published in: The American journal of tropical medicine and hygiene Vol. 79; no. 5; pp. 655 - 661
• Main Authors: Sagara, Issaka, Diallo, Abdoulbaki, Kone, Mamady, Coulibaly, Modibo, Diawara, Sory Ibrahima, Guindo, Ousmane, Maiga, Hamma, Niambele, Mohamed Balla, Sissoko, Mady, Dicko, Alassane, Djimde, Abdoulaye, Doumbo, Ogobara K
• Format: Journal Article
• Language: English
• Published: Deerfield, IL ASTMH 01.11.2008; American Society of Tropical Medecine and Hygiene
• Subjects: Animals; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials - administration & dosage; Antimalarials - therapeutic use; Antiparasitic agents; Artemisinins - administration & dosage; Artemisinins - therapeutic use; Base Sequence; Biological and medical sciences; DNA Primers; Drug Therapy, Combination; Ethanolamines - administration & dosage; Ethanolamines - therapeutic use; Fluorenes - administration & dosage; Fluorenes - therapeutic use; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Falciparum - drug therapy; Mali; Medical sciences; Mefloquine - administration & dosage; Mefloquine - therapeutic use; Parasitic diseases; Pharmacology. Drug treatments; Plasmodium falciparum; Plasmodium falciparum - isolation & purification; Polymerase Chain Reaction; Protozoal diseases; Treatment Outcome; Mali; Africa; Protozoa; Antimalarial; Apicomplexa; Protozoal disease; Mefloquine; Malaria; Parasitosis; Infection; Plasmodium falciparum; Treatment; Artesunate; Parasiticide; Artemether; Lumefantrine; Tropical medicine; Comparative study
• ISSN: 0002-9637; 1476-1645; 1476-1645
• DOI: 10.4269/ajtmh.2008.79.655

The choice of appropriate artemisin-based combination therapy depends on several factors (cost, efficacy, safety, reinfection rate, and simplicity of administration). In this study, we tested the hypothesis that artesunate-mefloquine (Artequin™) is as efficacious as artemether-lumefantrine (Coartem®) in treatment of uncomplicated Plasmodium falciparum malaria. The study was carried out from August 2004 through February 2005 in Kambila, Mali. Subjects with weights ≥ 10 kg and uncomplicated malaria were enrolled. Artesunate-mefloquine was given once a day for three days and artemether/lumefantrine twice a day for three days. A total of 470 (235 in each arm) patients were enrolled. The unadjusted 28-day cure rate was higher in artesunate-mefloquine arm than in the artemether-lumefantrine arm (79.7% versus 67.8%; P < 0.004). After correction for reinfection, the 28-day cure rates were similar in the two groups (96.04% versus 96.93%). Artesunate-mefloquine is well-tolerated and is as effective as artemether-lumefantrine for the treatment of P. falciparum malaria. Artesunate-mefloquine also prevented more new infections.