Mefloquine--its 20 years in the Thai Malaria Control Program

Area of Science:

• Tropical Medicine
• Pharmacology
• Infectious Diseases

Background:

• Sulfadoxine-pyrimethamine (SP) efficacy declined significantly by the mid-1970s.
• The Thai Malaria Control Program sought alternative treatments for falciparum malaria.
• Chloroquine- and SP-resistant Plasmodium falciparum strains necessitated new drug development.

Purpose of the Study:

• To review the pharmacology and usage of mefloquine in Thailand.
• To document mefloquine's role as a replacement for SP in malaria treatment.
• To highlight Thailand's extensive experience with mefloquine in national malaria control.

Main Methods:

• A large-scale field trial of mefloquine was initiated in 1983 on the Thai-Cambodian border.
• Over 60,000 patients were enrolled in the study.
• The study evaluated mefloquine's efficacy against resistant Plasmodium falciparum strains.

Main Results:

• Mefloquine was formally established as the first-line treatment for uncomplicated falciparum malaria in Thailand.
• Mefloquine has been utilized for over two decades in various treatment regimens.
• Current usage includes combination therapy with artesunate in specific regions.

Conclusions:

• Mefloquine has been instrumental in controlling malaria in Thailand.
• Thailand possesses the most extensive experience globally in implementing mefloquine within a national malaria control program.
• The review provides insights into mefloquine's pharmacology and its successful application in a real-world public health setting.