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Br Med J. 1977 June 25; 1(6077): 1626–1628.
PMCID: PMC1607727

Sequential treatment with quinine and mefloquine or quinine and pyrimethamine-sulfadoxine for falciparum malaria.

Abstract

Patients with falciparum malaria were studied in Thailand, an area of known chloroquine resistance. The patients were unselected and some had severe malaria, and they were randomly assigned to one of two sequential regimes. A short course of quinine (average 4 doses, equivalent to 2 g base) followed by a single dose of pyrimethamine-sulfadoxine (Fansidar) cured 92% of patients (36 out of 39), while a short course of quinine followed by a single 1-5-dose of mefloquine cured all of the 35 patients who could be followed up. Gastrointestinal side effects were minimal if at least 12 hours elapsed between the last dose of quinine and the mefloquine. Sequential quinine and mefloquine is the most effective treatment for patients with chloroquine-resistant falciparum malaria, including those with severe or complicated disease. Mefloquine, however, is not commercially available, and the similar regimen using Fansidar is almost as effective.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Harinasuta T, Suntharasamai P, Viravan C. Chloroquine-resistant falciparum malaria in Thailand. Lancet. 1965 Oct 2;2(7414):657–660. [PubMed]
  • Colwell EJ, Phintuyothin P, Sadudee N, Benjapong W, Neoypatimanondh S. Evaluation of an in vitro technique for detecting chloroquine resistant falciparum malaria in Thailand. Am J Trop Med Hyg. 1972 Jan;21(2):6–12. [PubMed]
  • Hall AP, Doberstyn EB, Mettaprakong V, Sonkom P. Falciparum malaria cured by quinine followed by sulfadoxine-pyrimethamine. Br Med J. 1975 Apr 5;2(5961):15–17. [PMC free article] [PubMed]
  • Trenholme CM, Williams RL, Desjardins RE, Frischer H, Carson PE, Rieckmann KH, Canfield CJ. Mefloquine (WR 142,490) in the treatment of human malaria. Science. 1975 Nov 21;190(4216):792–794. [PubMed]
  • Doberstyn EB, Hall AP, Vetvutanapibul K, Sonkon P. Single-dose therapy of Falciparum malaria using pyrimethamine in combination with diformyldapsone or sulfadoxine. Am J Trop Med Hyg. 1976 Jan;25(1):14–19. [PubMed]
  • Hall AP, Segal HE, Pearlman EJ, Phintuyothin P. Comparison of a 9-phenanthrene methanol (WR33063), a 4-quinoline methanol (WR30090), and quinine for falciparum malaria in Thailand. Trans R Soc Trop Med Hyg. 1975;69(3):342–349. [PubMed]
  • Peters W. The chemotherapy of rodent malaria, XXII. The value of drug-resistant strains of P. berghei in screening for blood schizontocidal activity. Ann Trop Med Parasitol. 1975 Jun;69(2):155–171. [PubMed]

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