Oral
artesunate is the most effective treatment for uncomplicated hyperparasitaemia in
falciparum malaria. To assess the contribution of
mefloquine to therapeutic efficacy in an area endemic for
mefloquine-resistant Plasmodium falciparum, an open randomized comparison of a 5 d course of oral
artesunate (total dose 12 mg/kg) with and without a single dose of
mefloquine (25 base mg/kg) was conducted in 100 adults and children with uncomplicated hyperparasitaemia (> 4% parasitized red blood cells). Both regimens were well tolerated and gave equally rapid clinical responses (84% of patients were aparasitaemic and 96% were afebrile within 48 h), but the recrudescence rate assessed at day 42 was 6% in those receiving
artesunate with
mefloquine compared to 36% in those receiving
artesunate alone (adjusted hazard ratio 7, 95% confidence interval [95% CI] 2-32; P < 0.01). In addition, the efficacy of
a 7 d course of
artesunate, with and without the addition of
mefloquine, was monitored in 178 patients who were not part of the randomized comparison. The failure rate was again lower in those receiving
artesunate and
mefloquine--7% (95% CI 2-13) compared with 26% (95% CI 8-44) in patients treated with
artesunate alone. An oral regimen of 5 d or more of
artesunate, together with
mefloquine (25 mg/kg) given on day 2, is an effective treatment for uncomplicated hyperparasitaemic
falciparum malaria in this area of high level multidrug resistance.