Mefloquine versus Quinine plus Sulphalene-Pyrimethamine (Metakelfin) for Treatment of Uncomplicated Imported Falciparum Malaria Acquired in Africa

Abstract

We conducted a multicenter, randomized, open-label trial to compare mefloquine with a 3-day quinine plus sulphalene-pyrimethamine (SP) regimen for the treatment of imported uncomplicated malaria acquired in Africa. The end points of the study were efficacy, tolerability, and length of hospital stay. From July 1999 to February 2003, 187 patients were enrolled in five centers in Italy, of whom 93 were randomized to receive mefloquine (the M group) and 94 were randomized to receive quinine plus SP (the QSP group). Immigrants and visiting relatives and friends represented 90% of the cases and were mainly from western African countries. A slightly increased proportion of cases in the QSP group had abnormal alanine aminotransferase levels at the baseline. The early cure rate was similar in the two groups: 98.9% (confidence interval [CI] ‫؍‬ 97 to 100%) in the M group and 96.8% (CI ‫؍‬ 93 to 100%) in the QSP group. The extended follow-up was completed by 135 subjects (72.2%), and no case of recrudescence was detected. There were no differences in the parasite clearance time, but patients in the M group had shorter mean fever clearance time (35.9 h versus 44.4 h for the QSP group; P ‫؍‬ 0.05) and a shorter mean hospital stay (3.9 days versus 4.6 days for the QSP group; P ‫؍‬ 0.007). The overall proportions of reported side effects were similar in the two groups, but patients in the M group had a significantly higher rate of central nervous system disturbances (29.0% versus 9.6% for the QSP group; P < 0.001).

Chronic malaria and hyper-reactive malarial splenomegaly: a retrospective study on the largest series observed in a non-endemic country

“…The anti-malarial antibody titre (IFAT, BioMérieux) was ≥160 (not further diluted). She was treated with quinine, 10 mg/kg × 3/day for 3 days, followed by a single dose of pyrimethamine–sulfametoxazole, the standard regimen for acute malaria at that time at CTD [ 10 ]. A short-term follow-up was not possible as the patient insisted on returning to the host country for urgent matters, but she agreed to follow a strict prophylaxis with doxycycline and to return for a follow-up as early as possible.…”

“…All patients were treated with a single anti-malarial, as for an acute malaria, once the diagnosis was established. The standard regimen followed at CTD was with oral quinine, 10 mg/kg × 3 for 3 days, followed by pyrimethamine–sulfametopyrazine (Metakelfin ® ) single dose [ 10 ], until the year 2002, then with artemisinin-based combination therapy (ACT), regimen currently in use. No further treatment or prophylaxis was indicated for patients remaining in Italy, while for those returning to endemic countries, a prophylaxis was indicated with doxycycline, and with mefloquine as a second choice.…”

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“…The high cure rate demonstrated for AS+-SMP (>90%) in this study was expected because of the synergistic effect of artesunate and SMP and potentially because of the non-wide use of SMP as an antimalarial in this country. Previously high efficacy of SMP for the treatment of uncomplicated P. falciparum malaria was reported in other African countries [ 8 - 10 ].…”

“…Sulfamethoxypyrazine (SM) is chemically very close to sulfadoxine but has different pharmacokinetics [ 6 , 7 ]. The high efficacy of sulfamethoxypyrazine-pyrimethamine (SMP) for treating P. falciparum malaria had been demonstrated previously [ 8 - 10 ]. It is expected that the combination of this drug with artesunate will result in a highly efficacious treatment for P. falciparum malaria.…”

Dramatically decreased therapeutic efficacy of chloroquine and sulfadoxine‐pyrimethamine, but not mefloquine, in southern Benin

“…Pharmacy prices are similar for both treatments, but MQ is available and locally distributed by two pharmaceutical companies. MQ has proven its high efficacy in Africa through assays carried out in Sudan (Adam et al 2004(Adam et al , 2005 and with tourists returning from West Africa (Matteelli et al 2005), who achieved cure rates of 92.5-98.5%. One study carried out in Malawi reported a worrying failure rate in 1998, as 22% of treatments failed parasitologically during the 14-day follow-up (MacArthur et al 2001).…”