Mefloquine for Uncomplicated Plasmodium falciparum Malaria in Children

Background: Children with uncomplicated Plasmodium falciparum imported malaria are treated with various antimalarial regimens including mefloquine depending on national guidelines. Little is known regarding mefloquine treatment efficacy in this setting. Methods: In this prospective study, children 3 months to 16 years of age admitted in a tertiary hospital emergency ward in France with uncomplicated P. falciparum malaria were treated with oral mefloquine. Each dose was given with an antiemetic. Results: Between 2004 and 2009, 95 children were evaluated. In all, 94% had traveled in the Indian Ocean region (Comoros and Madagascar); 79% used a malaria chemoprophylaxis, but none was fully compliant with World Health Organization recommended regimens. Main clinical features at admission were fever (91%), vomiting (44%), and headaches (44%). Hemoglobin < 80 g/L and platelets < 100 G/L were observed in 16% and 17%, respectively. All children were initially cured by mefloquine, and no relapse was noted within 45 days after admission. One Plasmodium vivax relapse occurred 6 months later. Vomiting within 1 hour after dosing occurred in 20% of children. Significant features associated with early vomiting by univariate analysis were a weight <= 15 kg, C-reactive protein >= 50 mg/L, and parasitemia >= 1%, but only low weight was significant by multivariate analysis. Conclusion: Mefloquine is an effective treatment for uncomplicated imported P. falciparum malaria in children returning from countries with low mefloquine resistance. Early vomiting after mefloquine dosing is frequent, especially in children <= 15 kg of weight, but a second dose can be given successfully.