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Am. J. Trop. Med. Hyg., 73(2), 2005, pp. 267-268
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


NO EVIDENCE OF CARDIOTOXICITY OF ATOVAQUONE-PROGUANIL ALONE OR IN COMBINATION WITH ARTESUNATE

RAVINDRA K. GUPTA, MICHELE VAN VUGT, LUCY PAIPHUN, THRA SLIGHT, SORNCHAI LOOAREESUWAN, NICHOLAS J. WHITE, AND FRANÇOIS NOSTEN*
Department of Infection, St. Thomas’ Hospital, London, United Kingdom; Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Headington, Oxford, United Kingdom

 

ABSTRACT

Combinations are set to become the mainstay in treatment and prophylaxis of malaria due to Plasmodium falciparum. Various antimalarials have been implicated in cardiotoxicity via prolongation of the QTc interval. Atovaquone-proguanil is an effective and increasingly popular antimalarial choice when used alone or with artesunate in areas of drug resistance. We report the results of an investigation carried out on the Thai-Burmese border in 42 patients randomized to receive either atovaquone-proguanil or atovaquone-proguanil-artesunate for three days. Electrocardiographic recordings were made at baseline and one hour after each dose. There was no statistically significant change in QTc interval between baseline and any subsequent readings in either treatment group or the cohort as a whole. We conclude that atovaquone-proguanil shows no evidence of cardiotoxicity either alone or when combined with artesunate.

Received December 23, 2004. Accepted for publication February 7, 2005.

Acknowledgments: We are grateful to the staff of the Shoklo Malaria Research Unit for their work and to the study participants.

Financial support: François Nosten and Nicholas J. White are supported by the Wellcome Trust of Great Britain. This investigation was part of the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program.

* Address correspondence to Dr. François Nosten, PO Box 46, Mae Sot 63110, Thailand. E-mail: SMRU{at}tropmedres.ac

Authors’ addresses: Ravindra K. Gupta, Shoklo Malaria Research Unit, PO Box 46, Mae Sot 63110, Thailand and Oxford University Medical School, Headington, Oxford OX3 9DU, United Kingdom. Michele van Vugt and Lucy Paiphun, Shoklo Malaria Research Unit, PO Box 46, Mae Sot 63110, Thailand and Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. Thra Slight, Shoklo Malaria Research Unit, PO Box 46, Mae Sot 63110, Thailand. Sornchai Looareesuwan, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. Nicholas J. White, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand and Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom. François Nosten, Shoklo Malaria Research Unit, PO Box 46, Mae Sot 63110, Thailand, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand, and Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom, E-mail: SMRU{at}tropmedres.ac.




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