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THE EFFICACY OF COMBINED MEFLOQUINE-ARTESUNATE VERSUS MEFLOQUINE-PRIMAQUINE ON SUBSEQUENT DEVELOPMENT OF PLASMODIUM FALCIPARUM GAMETOCYTEMIA

An open randomized controlled study of mefloquine-artesunate and mefloquine-primaquine for the treatment of uncomplicated Plasmodium falciparum malaria was carried out in Kanchanaburi in the Saiyok District in western Thailand. Weekly parasite counts from thick and thin blood films were done for six weeks. The gametocyte carriage rate was calculated and compared between the two treatment groups. Gametocytes on presentation, recrudescent infection, and reinfection were the significant factors associated with subsequent development of gametocytemia. It is the increased propensity of recrudescent infections to produce gametocytes that drives drug resistance. The results of this study confirmed that the complete eradication of asexual forms of P. falciparum by effective antimalarial treatment, but not by combination treatment with primaquine, is the most effective means to prevent subsequent gametocytemia.

Received May 7, 2002. Accepted for publication January 22, 2003.

Acknowledgments: We thank Professor Amorn Leelarasamee (Department of Medicine, Mahidol University), Professor Somwang Danchaivijitr (Division of Infectious Diseases and Tropical Medicine, Faculty of Medicine Siriraj Hospital), and Dr. Boonum Chaivisuth (Provincial Health Office, Kanchanaburi) for their permission to conduct this study; and Chairat Chayakul (Department of Medicine, Faculty of Medicine, Siriraj Hospital) and Kesinee Chotivanich (Wellcome Unit, Faculty of Tropical Medicine, Mahidol University) for their kind advice and supervision on the PCR genotyping of P. falciparum. We also thank Professor N. J. White (Wellcome Unit, Faculty of Tropical Medicine, Mahidol University) for his kind advice and useful discussions; Dr. Krongtong Thimasarn (Public Health Ministry of Thailand) for her advice; and the medical staffs and nurses of Saiyok Hospital, the health officers at Kang-Raberd, Khong-Pla, the Daowadung Health Center, Paitoon Niemhom, and Vitaya Saipongsuth (Malaria Center, Public Health Ministry of Thailand, Saiyok District, Kanchanaburi, Thailand) for their active collaborations.

Financial support: This study was supported by Mahidol University Research Grants 1999 and 2000.

Authors’ addresses: Yupin Suputtamongkol, Saowalak Silpasakorn, Suchada Chaikachonpatd, Naparat Kaewkaukul, and Visanu Thamlikitkul, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700,Thailand. Supat Chindarat and Kittiporn Chanthapakajee, Saiyok Hospital, Saiyok District, Kanchanaburi 71500, Thailand. Kimheng Lim, Bongtee Health Center, Saiyok District, Kanchanaburi 71500, Thailand.

Reprint requests: Yupin Suputtamongkol, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Telephone: 66-2-419-7203, Fax: 66-2-412-5994, E-mail: siysp{at}mahidol.ac.th

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