Predictors of mefloquine treatment failure: a prospective study of 1590 patients with uncomplicated falciparum malaria

Transactions of the Royal Society of Tropical Medicine and Hygiene
F O ter KuileN J White

Abstract

The factors which identify patients at risk of treatment failure were characterized in 1590 children and adults with uncomplicated falciparum malaria treated with 15 or 25 mg/kg of mefloquine on the borders of Thailand. Six independent predictors of failure were identified using multiple logistic regression. Age < or = 2 years (odds ratio [OR] 4.54), 3-15 years (OR 4.4), vomiting < 30 min after a single dose of 25 mg/kg (despite re-administration of the dose) (OR 2.5) and diarrhoea after treatment (OR 3.6) were the strongest predictors of failure by day 7. Parasitaemias > 10 000/mm3 (OR 1.4), and fever with a history of recent vomiting (OR 1.6) were risk factors for recrudescence of the infection between days 10 and 28. Patients treated with mefloquine in the previous 2 months were also at increased risk of failure (OR 2.38), particularly if they were anaemic (haematocrit < 30%) (OR 5.96), which suggested that they had recrudescent infections at presentation. Combined, these 6 factors identified half of all treatment failures. Vomiting and diarrhoea accounted for 24% of the early failures in children. Patients at increased risk of treatment failure should be monitored closely and given early alternative treatment if fever and p...Continue Reading

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Citations

Mar 20, 2010·European Journal of Clinical Pharmacology·Elizabeth A AshleyFrançois Nosten
May 17, 2005·Acta Tropica·Anders Björkman, Achuyt Bhattarai
Aug 23, 2008·Transactions of the Royal Society of Tropical Medicine and Hygiene·Ishag AdamElfatih M Malik
Jun 12, 2002·Transactions of the Royal Society of Tropical Medicine and Hygiene·Poul-Erik KofoedLars Rombo
Feb 17, 1998·Transactions of the Royal Society of Tropical Medicine and Hygiene·R N PriceN J White
Oct 9, 1998·Transactions of the Royal Society of Tropical Medicine and Hygiene·R PriceN J White
Dec 23, 1998·Transactions of the Royal Society of Tropical Medicine and Hygiene·C LuxemburgerF Nosten
May 18, 2006·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·F Ellis McKenzieRobert A Gasser
May 21, 2011·The Pediatric Infectious Disease Journal·Philippe MinodierStephane Ranque
Nov 12, 2010·Journal of the Royal Society, Interface·Charles F BellowsJoseph D Brain
Mar 19, 2003·Proceedings. Biological Sciences·N J White, W Pongtavornpinyo
Sep 15, 2001·Antimicrobial Agents and Chemotherapy·P CravoM J Mackinnon
Mar 19, 2002·Antimicrobial Agents and Chemotherapy·Shusuke NakazawaHiroji Kanbara
Oct 27, 2004·Antimicrobial Agents and Chemotherapy·Kasia StepniewskaNicholas J White
Jul 26, 2005·Infection and Immunity·Tatiana VozaLaurent Rénia
Oct 11, 2011·Malaria Journal·Patricia SchlagenhaufHans-Georg Rhein
May 1, 2012·Malaria Journal·Nicholas M DouglasRic N Price
Sep 8, 2007·Malaria Journal·Karen I BarnesNicholas J White
Dec 19, 2007·Malaria Journal·Gideon K HelegbeBartholomew D Akanmori
Nov 13, 2009·Malaria Journal·Nicholas J WhiteNicholas P J Day

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