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

Autor: Huynh Hong Quang, Nguyen Thi Le Hang, Nguyen Tan Thoa, Sean Hewitt, Pham Thi Thuy, Luu Thi Hong Giang, Le Khanh Thuan, Cao Van Anh, Vo Thanh Tuan, Trieu Nguyen Trung, Timothy M. E. Davis
Rok vydání: 2001
Předmět:
Male
Endemic Diseases
medicine.medical_treatment
Drug Resistance
Artesunate
Parasitemia
chemistry.chemical_compound
0302 clinical medicine
Parasitic Sensitivity Tests
Recurrence
Malaria
Falciparum
Child
education.field_of_study
biology
Mefloquine
Age Factors
Artemisinins
Vietnam
Child
Preschool
Regression Analysis
Drug Therapy
Combination
Female
Sesquiterpenes
medicine.drug
Adult
medicine.medical_specialty
Combination therapy
Adolescent
030231 tropical medicine
Population
Statistics
Nonparametric
03 medical and health sciences
Antimalarials
030225 pediatrics
Internal medicine
parasitic diseases
medicine
Humans
education
Chemotherapy
business.industry
Plasmodium falciparum
biology.organism_classification
medicine.disease
Surgery
Directly Observed Therapy
chemistry
El Niño
Pediatrics
Perinatology and Child Health
Linear Models
business
Malaria
Zdroj: Annals of tropical paediatrics. 21(4)
ISSN: 0272-4936
Popis: 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).
Databáze: OpenAIRE
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