Journal Article

Treatment of Uncomplicated Multidrug-Resistant Falciparum Malaria with Artesunate-Atovaquone-Proguanil

Michèle van Vugt, Elisabetta Leonardi, Lucy Phaipun, Thra Slight, Kyaw Lay Thway, Rose McGready, Alan Brockman, Leopoldo Villegas, Sornchai Looareesuwan, Nicholas J. White and François Nosten

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 35, issue 12, pages 1498-1504
Published in print December 2002 | ISSN: 1058-4838
Published online December 2002 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/344901
Treatment of Uncomplicated Multidrug-Resistant Falciparum Malaria with Artesunate-Atovaquone-Proguanil

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In an open-label trial carried out on the northwest border of Thailand, 1596 patients with uncomplicated multidrug-resistant falciparum malaria were randomly assigned to receive atovaquone-proguanil, atovaquone-proguanil-artesunate, or artesunate-mefloquine and were followed up for 42 days. All 3 regimens were highly effective and well tolerated. Fever duration and parasite clearance times were significantly shorter among patients who received artesunate (P <.001). Polymerase chain reaction genotyping confirmed that recrudescence occurred in 13 patients who received artesunate-mefloquine (2.4%), 5 who received atovaquone-proguanil-artesunate (0.9%), and 15 who received atovaquone-proguanil (2.8%). Adding artesunate to atovaquone-proguanil reduced the risk of failure 3-fold (95% confidence interval [CI], 1.1–8.2) and subsequent gametocyte carriage 21-fold (95% CI, 14–30). Gastrointestinal complaints in the first 48 h after initiation of treatment were more common among artesunate recipients, but after day 2, dizziness, sleep disturbance, nausea, vomiting, and anorexia were more common among mefloquine recipients (P ⩽.014). Artesunate-atovaquone-proguanil is a highly effective and well-tolerated treatment for multidrug-resistant falciparum malaria.

Journal Article.  3994 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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