Volume 50, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



New treatments for malaria are urgently needed in areas such as Thailand where highly drug-resistant strains of are prevalent. Mefloquine is rapidly losing efficacy and conventional doses of halofantrine are ineffective. We therefore used pharmacokinetic simulation to design an extended-dose halofantrine regimen and tested it in 26 soldiers stationed along the Thai-Cambodian border. Halofantrine was given after meals as three doses of 500 mg each at 4-hr intervals on the first day, followed by 500 mg a day for six days (total dose 4.5 g). Twenty-six soldiers treated with quininetetracycline for seven days (QT) served as controls. There were no significant differences in efficacy between halofantrine and QT ( > 0.1) as assessed by cure rate (92% versus 85%), mean parasite clearance time (82 hr versus 81 hr), or mean fever clearance time (93 hr versus 99 hr). Halofantrine was better tolerated than QT. The side effects score was lower (2 versus 11; < 0.001), there were less days on which side effects occurred (2.0 days versus 5.5 days; < 0.001), and fewer patients had adverse effects on every treatment day (4% versus 42%; < 0.01). High-dose halofantrine is as effective and better tolerated than quinine-tetracycline for multidrug-resistant falciparum malaria.


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