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

Authors

David J. Fryauff, US Naval Medical Research Unit No. 3Follow
Seth Owusu-Agyel, Navrongo Health Research Center, Navrongo, Upper East Region, Ghana
Gregory Utz, US Naval Medical Research Unit No. 3
J. Kevin Baird, ALERTAsia FoundationFollow
Kwadwo A. Koram, Noguchi Memorial Institute of Medical Research, University of Ghana
Fred Binka, School of Public Health, University of Ghana, Legon, Ghana
Francis Nkrumah, Noguchi Memorial Institute of Medical Research, University of Ghana
Stephen L. Hoffman, Sanaria Inc., 12511 Parklawn Drive, Suite L, Rockvile, MD

Date of this Version

2007

Citation

Am. J. Trop. Med. Hyg., 76(2), 2007, pp. 224–231

Comments

U.S. Government Work.

Abstract

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/L against a MQ blood concentration of 550 ng/mL was taken as indication of tolerance to suppressive levels of the drug at this location.