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MEFLOQUINE TREATMENT FOR UNCOMPLICATED FALCIPARUM MALARIA IN YOUNG CHILDREN 6–24 MONTHS OF AGE IN NORTHERN GHANA

DAVID J. FRYAUFFUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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SETH OWUSU-AGYEIUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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GREGORY UTZUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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J. KEVIN BAIRDUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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KWADWO A. KORAMUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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FRED BINKAUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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FRANCIS NKRUMAHUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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STEPHEN L. HOFFMANUS Naval Medical Research Unit No. 3, Cairo, Egypt; Navrongo Health Research Center, Navrongo, Upper East Region, Ghana; Naval Medical Research Center, Silver Spring, Maryland; Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; Department of Public Health and Epidemiology, School of Public Health, University of Ghana, Legon, Ghana

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Mefloquine (MQ) single dose 20 mg/kg treatment of falciparum malaria was evaluated in 186 children of 6–24 months of age in northern Ghana. There were 15 RII/RIII-type parasitologic failures, all with Day 2 MQ blood levels significantly lower than children whose parasitemias cleared before Day 7 and remained clear through 28 days. Predictors of RII/RIII parasitologic response were vomiting after MQ dosing, Day 2 MQ levels < 500 ng/mL, and undetectable Day 2 levels of the carboxymefloquine metabolite. There were 50 cases of delayed RI parasitologic failure, but 71% of these cases had undetectable Day 28 blood levels of MQ and drug levels in the remaining 29% ranged below the 620 ng/mL level that suppresses MQ sensitive strains of P. falciparum. Drug levels among infants that tolerated MQ well were not associated with age, weight, hemoglobin, parasitemia, and pre-existing symptoms of vomiting or diarrhea. An observed recurrent parasitemia of 34,400 trophozoites/μL against a MQ blood concentration of 550 ng/mL was taken as indication of tolerance to suppressive levels of the drug at this location.

Author Notes

Reprint requests: Research Publications Branch, US Naval Medical Research Unit No. 3, PSC 452 Box 5000, FPO AE 09835-0007. E-mail: KaramE@namru3.med.navy.mil.
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