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The Journal of the Royal Institute of Thailand Volume II - 2010 Prakaykaew Charunwatthana, Sasithon 103 Artesunate plus mefloquine Since mid-1994 mefloquine has been combined with a 3-day course of artesunate, and there has been no further decline in mefloquine sensitivity. More recently artemisinin and its derivatives in combination with mefloquine, have been very effective. They have accelerated recoveries, increased cure rates, reduced transmissibility and appear also to have delayed the further development of resistance and reduced the incidence of disease. Artesunate plus mefloquine is currently available as blister packs with separate scored tablets containing 50 mg of artesunate and 250 mg base of mefloquine, respectively. A fixed-dose formulation of artesunate and mefloquine is at an advanced stage of development. A target dose of 4 mg/kg/day artesunate given once a day for 3 days and 25 mg/kg of mefloquine either split over 2 days as 15 mg/kg or 10 mg/kg over 3 days, equivalent to 8.3 mg/kg/day once a day for 3 days. Figure 3 Combining an artemisinin derivative (in this case artesunate given for 3 days: shaded box at the top left of the panel) with mefloquine improves cure rates. This is because the parasites that remain after artesunate has been stopped are exposed to much higher concentrations of mefloquine (a to b on the mefloquine blood concentration profile) than the corresponding residium of viable parasites (shown as equivalent shaded areas under the parasite-time graphs) when mefloquine is used alone (c to d). Blood mefloquine levels are shown as a broken line. (adapted from Pukrittayakamee & White, 2002)