Volume 85, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We evaluated the efficacy and effectiveness of mefloquine (MQ) plus artesunate (AS) to treat patients with uncomplicated malaria in the Peruvian Amazon Basin in April 2005–March 2006. Patients ≥ 1 year of age with fever (axillary temperature ≥ 37.5°C) or history of fever and monoinfection were included. Patients received antimalarial treatment with MQ (12.5 mg/kg/day for two days) and AS (4.0 mg/kg/day for three days) either by directly observed therapy or without directly observed therapy. After a 28-day follow-up, treatment efficacy and effectiveness were assessed on the basis of clinical and parasitologic outcomes. Ninety-six patients were enrolled in each study group; nine patients were lost to follow-up. All patients, except for one in the observed group, demonstrated adequate clinical and parasitologic response; none had detectable parasitemia on day 3. The efficacy of MQ + AS efficacy was 98.9% (95% confidence interval = 94.1–100.0%) and the effectiveness was 100.0% (95% confidence interval = 95.9–100.0%). Our study shows that MQ + AS is highly efficacious in the Peruvian Amazon.


Article metrics loading...

Loading full text...

Full text loading...



  1. Magill AJ, Zegarra J, Garcia C, Marquino W, Ruebush TK II, , 2004. Efficacy of sulfadoxine-pyrimethamine and mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon basin of Peru. Rev Soc Bras Med Trop 37: 279281.[Crossref]
  2. Marquino W, Huilca M, Calampa C, Falconi E, Cabezas C, Naupay R, Ruebush TK II, , 2003. Efficacy of mefloquine and a mefloquine-artesunate combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon Basin of Peru. Am J Trop Med Hyg 68: 608612.
  3. Williams HA, Vincent-Mark A, Herrera Y, Chang OJ, , 2009. A retrospective analysis of the change in anti-malarial treatment policy: Peru. Malar J 8: 85.[Crossref]
  4. Gbotosho GO, Happi CT, Ganiyu A, Ogundahunsi OA, Sowunmi A, Oduola AM, , 2009. Potential contribution of prescription practices to the emergence and spread of chloroquine resistance in south-west Nigeria: caution in the use of artemisinin combination therapy. Malar J 8: 313.[Crossref]
  5. Durand SMW, Ruebush TK, Cairo J, Carrion R, Quintana F, Bellina C, Rodriguez H, Utz GC, , 2004. Assessment of the Implementation of Mefloquine-Artesunate and Sulfadoxine-Pyrimethamine-Artesunate Combination Therapies for Plasmodium falciparum Malaria in Peru. American Society of Tropical Medicine and Hygiene Annual Meeting, Miami, Florida.
  6. 2001. Sistema de Vigilancia de la Resistencia a Medicamentos Antimalaricos en el Peru. Lima, Peru: Instituto Nacional de Salud.
  7. 2003. Boletin Epidemiologico. Semana Epidemiologica No. 51. Lima, Peru: Instituto Nacional de Salud.
  8. Pan American Health Organization, 1998. Evaluacion de la Eficacia Terapeutica de Los Medicamentos para el Tratamiento del Paludismo por Plasmodium falciparum sin Ccomplicaciones en las Americas. Washington, DC: Pan American Health Organization.
  9. World Health Organization, 2003. Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated falciparum Malaria. Geneva: World Health Organization.
  10. World Health Organization, 2009. Methods for Surveillance of Antimalarial Drug Efficacy. Geneva: World Health Organization.
  11. McCollum AM, Mueller K, Villegas L, Udhayakumar V, Escalante AA, , 2007. Common origin and fixation of Plasmodium falciparum dhfr and dhps mutations associated with sulfadoxine-pyrimethamine resistance in a low-transmission area in South America. Antimicrob Agents Chemother 51: 20852091.[Crossref]
  12. Anderson TJ, Su XZ, Bockarie M, Lagog M, Day KP, , 1999. Twelve microsatellite markers for characterization of Plasmodium falciparum from finger-prick blood samples. Parasitology 119: 113125.[Crossref]
  13. Stepniewska K, Ashley E, Lee SJ, Anstey N, Barnes KI, Binh TQ, D'Alessandro U, Day NP, de Vries PJ, Dorsey G, Guthmann JP, Mayxay M, Newton PN, Olliaro P, Osorio L, Price RN, Rowland M, Smithuis F, Taylor WR, Nosten F, White NJ, , 2010. In vivo parasitological measures of artemisinin susceptibility. J Infect Dis 201: 570579.[Crossref]
  14. Gutman J, Green M, Durand S, Rojas OV, Ganguly B, Quezada WM, Utz GC, Slutsker L, Ruebush TK II, Bacon DJ, , 2009. Mefloquine pharmacokinetics and mefloquine-artesunate effectiveness in Peruvian patients with uncomplicated Plasmodium falciparum malaria. Malar J 8: 58.[Crossref]
  15. Nosten F, van Vugt M, Price R, Luxemburger C, Thway KL, Brockman A, McGready R, ter Kuile F, Looareesuwan S, White NJ, , 2000. Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study. Lancet 356: 297302.[Crossref]
  16. World Health Organization, 2010. Guidelines for the Treatment of Malaria. Geneva: World Health Organization.
  17. ter Kuile FO, Nosten F, Luxemburger C, Kyle D, Teja-Isavatharm P, Phaipun L, Price R, Chongsuphajaisiddhi T, White NJ, , 1995. Mefloquine treatment of acute falciparum malaria: a prospective study of non-serious adverse effects in 3,673 patients. Bull World Health Organ 73: 631642.
  18. Price R, van Vugt M, Phaipun L, Luxemburger C, Simpson J, McGready R, ter Kuile F, Kham A, Chongsuphajaisiddhi T, White NJ, Nosten F, , 1999. Adverse effects in patients with acute falciparum malaria treated with artemisinin derivatives. Am J Trop Med Hyg 60: 547555.
  19. Agomo PU, Meremikwu MM, Watila IM, Omalu IJ, Odey FA, Oguche S, Ezeiru VI, Aina OO, , 2008. Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria. Malar J 7: 172.[Crossref]
  20. Fraser B, , 2006. Providing medical care in the Peruvian Amazon. Lancet 368: 14081409.[Crossref]
  21. Quick RE, Vargas R, Moreno D, Mujica O, Beingolea L, Palacios AM, Seminario L, Tauxe RV, , 1993. Epidemic cholera in the Amazon: the challenge of preventing death. Am J Trop Med Hyg 48: 597602.
  22. Zhou Z, Griffing SM, de Oliveira AM, McCollum AM, Quezada WM, Arrospide N, Escalante AA, Udhayakumar V, , 2008. Decline in sulfadoxine-pyrimethamine-resistant alleles after change in drug policy in the Amazon region of Peru. Antimicrob Agents Chemother 52: 739741.[Crossref]
  23. Kublin JG, Cortese JF, Njunju EM, Mukadam RA, Wirima JJ, Kazembe PN, Djimde AA, Kouriba B, Taylor TE, Plowe CV, , 2003. Reemergence of chloroquine-sensitive Plasmodium falciparum malaria after cessation of chloroquine use in Malawi. J Infect Dis 187: 18701875.[Crossref]
  24. Laufer MK, Thesing PC, Eddington ND, Masonga R, Dzinjalamala FK, Takala SL, Taylor TE, Plowe CV, , 2006. Return of chloroquine antimalarial efficacy in Malawi. N Engl J Med 355: 19591966.[Crossref]
  25. Lim P, Alker AP, Khim N, Shah NK, Incardona S, Doung S, Yi P, Bouth DM, Bouchier C, Puijalon OM, Meshnick SR, Wongsrichanalai C, Fandeur T, Le Bras J, Ringwald P, Ariey F, , 2009. Pfmdr1 copy number and arteminisin derivatives combination therapy failure in falciparum malaria in Cambodia. Malar J 8: 11.[Crossref]
  26. Vestergaard LS, Ringwald P, , 2007. Responding to the challenge of antimalarial drug resistance by routine monitoring to update national malaria treatment policies. Am J Trop Med Hyg 77: 153159.
  27. Kachur SP, Khatib RA, Kaizer E, Fox SS, Abdulla SM, Bloland PB, , 2004. Adherence to antimalarial combination therapy with sulfadoxine-pyrimethamine and artesunate in rural Tanzania. Am J Trop Med Hyg 71: 715722.
  28. Krause G, Sauerborn R, , 2000. Comprehensive community effectiveness of health care. A study of malaria treatment in children and adults in rural Burkina Faso. Ann Trop Paediatr 20: 273282.[Crossref]
  29. Dharia NV, Plouffe D, Bopp SE, Gonzalez-Paez GE, Lucas C, Salas C, Soberon V, Bursulaya B, Kochel TJ, Bacon DJ, Winzeler EA, , 2010. Genome scanning of Amazonian Plasmodium falciparum shows subtelomeric instability and clindamycin-resistant parasites. Genome Res 20: 15341544.[Crossref]

Data & Media loading...

  • Received : 20 Apr 2011
  • Accepted : 11 Jun 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error