Therapeutic efficacy of mefloquine and sulfadoxine/pyrimethamine for the treatment of uncomplicated pasmodium falciparum malaria in children, Metehara town, Southeast Ethiopia

Abstract

Background: The development of resistance by P. falciparum to most drugs used in prophylaxis and therapeutics underscores the need to investigate the sensitivity of local parasite isolates to the currently available standard antimalarial drugs. Objective: To assess parasitological resistance and therapeutic efficacy of mefloquine (MQ) and sulfadoxine/pyrimethamine (SP) in children with uncomplicated falciparum malaria in Metehara town, southeast Ethiopia. Methods: The therapeutic responses to MQ and SP were examined using the World Health Organization 14-day in vivo test protocol. A total of 119 children that fulfilled the inclusion criteria were assigned to the MQ (n=59) or SP (n=50) treatment group. The patients were followed up for 14 days, and clinical and parasitological outcomes were assessed. Results: The 14-day clinical and parasitological cure rates in children treated with MQ were found to be 100% (55/55) with no recrudescence until day 14. In the SP group, the clinical cure and failure rates were found to be 78.9% (45/57) and 12% (7/57), respectively. Out of the patients with clinical failure in the SP group, one child was classified as early treatment failure and six had late treatment failure. The incidence of parasitological resistance was 21.1% (8 patients with RI and, 4 patients with RII). MQ produced faster fever and parasite clearance rate by day 2 (76.4%) and day 3 (98.2%) than SP (64.9% day 2 and 91.2% day 3). Gametocyte carrier rate following therapy was significantly lower in those treated with MQ than in those receiving SP; 1.8% with MQ had gametocytes by day 14 compared to 50.9% with SP (P=<0.001). Adverse events to both drugs were mild and few, with no incidence MQ- and SP-induced psychosis or Steven Johnson Syndrome. Conclusion: These findings show that MQ (15 mg base/kg), administered as a single oral dose, was highly effective and well tolerated in the treatment of uncomplicated falciparum malaria achieving a cure rate of 100% of treated children in this endemic area. However, a dramatic increase in the frequency of parasite resistance to SP was demonstrated compared with the incidence two years previously.