Mefloquine - Its 20 years in the Thai Malaria Control Program

Due to the deteriorating efficacy of sulfadoxine-pyrimethamine (SP or Fansidar®), from the mid-1970s the Thai Malaria Control Program was actively involved in testing potential replace- ment drugs to be used as the primary therapy for falciparum malaria in Thailand. In 1983, a large- scale field trial of mefloquine, a long-acting antimalarial drug known for its efficacy against chloro- quine- and SP-resistant Plasmodium falciparum, was initiated on the Thai-Cambodian border. The study enrolled over 60,000 patients and eventually led to the formal establishment of mefloquine as the first line drug for the treatment of uncomplicated falciparum malaria in the country. Mefloquine has played a significant role in the control of malaria in Thailand for the past two decades, initially in combination with SP, then by itself, and currently in selected areas as a partner drug in the combina- tion therapy with artesunate. Thailand is the country with the most experience in the use of this drug in a malaria control program. We present here a review of mefloquine's pharmacology and usage in Thailand.