1921
Volume 73, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

We assessed the efficacy and safety of a seven-day course of artesunate for the treatment of uncomplicated malaria in 55 non-immune patients living in Bangui, Central African Republic. The parasitologic cure rates were 100%, 95%, and 85% on days 14, 28, and 42, respectively. There were no significant differences in parasitemia density, 50% inhibitory concentration of dihydroartemisinin, and frequency of mutant multidrug resistance 1 codon 86 between patients who were cured and those who displayed recrudescence. However, the 90% inhibitory concentration for dihydroartemisinin and the number of genotypes isolated were both higher in the recrudescent patients (five- and two-fold, respectively). We found an association between recrudescence and decreased sensitivity. This suggests that the use of artemisinin compounds alone will select resistant strains. We conclude that artesunate should not be used in monotherapy even in seven-day courses, but only in combination with other anti-malarials to prevent the emergence of resistant

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2005.73.616
2005-09-01
2018-12-12
Loading full text...

Full text loading...

/deliver/fulltext/14761645/73/3/0730616.html?itemId=/content/journals/10.4269/ajtmh.2005.73.616&mimeType=html&fmt=ahah

References

  1. Basco LK, Same-Ekobo A, Ngane VF, Ndounga M, Metoh T, Ringwald P, Soula G, 2002. Therapeutic efficacy of sulfadoxine-pyrimethamine, amodiaquine and the sulfadoxine-pyrimethamine-amodiaquine combination against uncomplicated Plasmodium falciparum malaria in young children in Cameroon. Bull World Health Organ 80 : 538–545. [Google Scholar]
  2. Kazadi WM, Vong S, Makina BN, Mantshumba JC, Kabuya W, Kebela BI, Ngimbi NP, 2003. Assessing the efficacy of chloroquine and sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum malaria in the Democratic Republic of Congo. Trop Med Int Health 8 : 868–875. [Google Scholar]
  3. Ndong JM, Atteke C, Aubouy A, Bakary M, Lebibi J, Deloron P, 2003. In vitro activity of chloroquine, quinine, mefloquine and halofantrine against Gabonese isolates of Plasmodium falciparum. Trop Med Int Health 8 : 25–29. [Google Scholar]
  4. Nsimba B, Malonga DA, Mouata AM, Louya F, Kiori J, Malanda M, Yocka D, Oko-Ossho J, Ebata-Mongo S, Le Bras J, 2004. Efficacy of sulfadoxine/pyrimethamine in the treatment of uncomplicated Plasmodium falciparum malaria in Republic of Congo. Am J Trop Med Hyg 70 : 133–138. [Google Scholar]
  5. Pierce PF, Milhous WK, Campbell CC, 1987. Clinical and laboratory characterization of a chloroquine-resistant Plasmodium falciparum strain acquired in the Central African Republic. Am J Trop Med Hyg 36 : 1–2. [Google Scholar]
  6. Belec L, Delmont J, Vesters I, Testa J, Christian KS, Georges AJ, 1988. Emergence of multiresistant Plasmodium falciparum malaria in Central Aforcan Republic. Presse Med 17 : 2090–2091. [Google Scholar]
  7. Menard D, Madji N, Manirazika A, Djalle D, Koula MR, Talarmin A, 2005. Efficacy of chloroquine, amodiaquine, sulfadoxine-pyrimethamine, chloroquine-sulfadoxine-pyrimeth-amine combination, and amodiaquine-sulfadoxine-pyrimeth-amine combination in Central African children with noncom-plicated malaria. Am J Trop Med Hyg 72 : 581–585. [Google Scholar]
  8. de Vries PJ, Dien TK, 1996. Clinical pharmacology and therapeutic potential of artemisinin and its derivatives in the treatment of malaria. Drugs 52 : 818–836. [Google Scholar]
  9. Price RN, Nosten F, Luxemburger C, ter Kuile FO, Paiphun L, Chongsuphajaisiddhi T, White NJ, 1996. Effects of artemisinin derivatives on malaria transmissibility. Lancet 347 : 1654–1658. [Google Scholar]
  10. Borrmann S, Adegnika AA, Missinou MA, Binder RK, Issifou S, Schindler A, Matsiegui PB, Kun JF, Krishna S, Lell B, Kremsner PG, 2003. Short-course artesunate treatment of uncomplicated Plasmodium falciparum malaria in Gabon. Antimicrob Agents Chemother 47 : 901–904. [Google Scholar]
  11. Bunnag D, Viravan C, Looareesuwan S, Karbwang J, Harinasuta T, 1991. Double blind randomised clinical trial of oral artesunate at once or twice daily dose in falciparum malaria. Southeast Asian J Trop Med Public Health 22 : 539–543. [Google Scholar]
  12. Li GQ, Guo XB, Fu LC, Jian HX, Wang XH, 1994. Clinical trials of artemisinin and its derivatives in the treatment of malaria in China. Trans R Soc Trop Med Hyg 88 (Suppl 1): S5–S6. [Google Scholar]
  13. Alin MH, Kihamia CM, Bjorkman A, Bwijo BA, Premji Z, Mtey GJ, Ashton M, 1995. Efficacy of oral and intravenous artesunate in male Tanzanian adults with Plasmodium falciparum malaria and in vitro susceptibility to artemisinin, chloroquine, and mefloquine. Am J Trop Med Hyg 53 : 639–645. [Google Scholar]
  14. Ezedinachi E, 1996. In vivo efficacy of chloroquine, halofantrine, pyrimethamine-sulfadoxine and qinghaosu (artesunate) in the treatment of malaria in Calabar, Nigeria. Cent Afr J Med 42 : 109–111. [Google Scholar]
  15. Hassan Alin M, Ashton M, Kihamia CM, Mtey GJ, Bjorkman A, 1996. Multiple dose pharmacokinetics of oral artemisinin and comparison of its efficacy with that of oral artesunate in falciparum malaria patients. Trans R Soc Trop Med Hyg 90 : 61–65. [Google Scholar]
  16. WHO, 2000. The Use of Antimalarial Drugs: Report of an Informal Consultation. Geneva: World Health Organization. November 13–17, 2000. WHO/CDS/RBM/2001.33. Available from http://rbm.who.int/cmc_upload/0/000/014/923/use_of_antimalarials.pdf.
  17. Adjuik M, Babiker A, Garner P, Olliaro P, Taylor W, White N; International Artemisinin Study Group, 2004. Artesunate combinations for treatment of malaria: meta-analysis. Lancet 363 : 9–17. [Google Scholar]
  18. Grace JM, Aguilar AJ, Trotman KM, Peggins JO, Brewer TG, 1998. Metabolism of beta-arteether to dihydroqinghaosu by human liver microsomes and recombinant cytochrome P450. Drug Metab Dispos 26 : 313–317. [Google Scholar]
  19. Lee IS, Hufford CD, 1990. Metabolism of antimalarial sesquiterpene lactones. Pharmacol Ther 48 : 345–355. [Google Scholar]
  20. Desjardins RE, Canfield CJ, Haynes JD, Chulay JD, 1979. Quantitative assessment of antimalarial activity in vitro by a semiautomated microdilution technique. Antimicrob Agents Chemother 16 : 710–718. [Google Scholar]
  21. Zwetyenga J, Rogier C, Tall A, Fontenille D, Snounou G, Trape JF, Mercereau-Puijalon O, 1998. No influence of age on infection complexity and allelic distribution in Plasmodium falciparum infections in Ndiop, a Senegalese village with seasonal, mesoendemic malaria. Am J Trop Med Hyg 59 : 726–735. [Google Scholar]
  22. Kimura E, Mattei D, di Santi SM, Scherf A, 1990. Genetic diversity in the major merozoite surface antigen of Plasmodium falciparum: high prevalence of a third polymorphic form detected in strains derived from malaria patients. Gene 91 : 57–62. [Google Scholar]
  23. Borre MB, Dziegiel M, Hogh B, Petersen E, Rieneck K, Riley E, Meis JF, Aikawa M, Nakamura K, Harada M, 1991. Primary structure and localization of a conserved immunogenic Plasmodium falciparum glutamate rich protein (GLURP) expressed in both the preerythrocytic and erythrocytic stages of the vertebrate life cycle. Mol Biochem Parasitol 49 : 119–131. [Google Scholar]
  24. Duraisingh MT, Roper C, Walliker D, Warhurst DC, 2000. Increased sensitivity to the antimalarials mefloquine and artemisinin is conferred by mutations in the pfmdr1 gene of Plasmodium falciparum. Mol Microbiol 36 : 955–961. [Google Scholar]
  25. Molineaux L, Diebner HH, Eichner M, Collins WE, Jeffery GM, Dietz K, 2001. Plasmodium falciparum parasitaemia described by a new mathematical model. Parasitology 122 : 379–391. [Google Scholar]
  26. Nguyen DS, Dao BH, Nguyen PD, Nguyen VH, Le NB, Mai VS, Meshnick SR, 1993. Treatment of malaria in Vietnam with oral artemisinin. Am J Trop Med Hyg 48 : 398–402. [Google Scholar]
  27. Giao PT, Binh TQ, Kager PA, Long HP, van Thang N, van Nam N, de Vries PJ, 2001. Artemisinin for treatment of uncomplicated falciparum malaria: is there a place for monotherapy? Am J Trop Med Hyg 65 : 690–695. [Google Scholar]
  28. Cattamanchi A, Kyabayinze D, Hubbard A, Rosenthal PJ, Dorsey G, 2003. Distinguishing recrudescence from reinfection in a longitudinal antimalarial drug efficacy study: comparison of results based on genotyping of msp-1, msp-2, and glurp. Am J Trop Med Hyg 68 : 133–139. [Google Scholar]
  29. WHO, 2003. Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Geneva: World Health Organization. WHO/HTM/RBM/2003.50. Available from http://mosquito.who.int/cmc_upload/0/000/017/017/ProtocolWHO.pdf
  30. Stepniewska K, Taylor WR, Mayxay M, Price R, Smithuis F, Guthmann JP, Barnes K, Myint HY, Adjuik M, Olliaro P, Pukrittayakamee S, Looareesuwan S, Hien TT, Farrar J, Nosten F, Day NP, White NJ, 2004. In vivo assessment of drug efficacy against Plasmodium falciparum malaria: duration of follow-up. Antimicrob Agents Chemother 48 : 4271–4280. [Google Scholar]
  31. Ringwald P, Bickii J, Basco LK, 1999. In vitro activity of dihydroartemisinin against clinical isolates of Plasmodium falciparum in Yaounde, Cameroon. Am J Trop Med Hyg 61 : 187–192. [Google Scholar]
  32. Thanh NV, Cowman AF, Hipgrave D, Kim TB, Phuc BQ, Cong LD, Biggs BA, 2001. Assessment of susceptibility of Plasmodium falciparum to chloroquine, quinine, mefloquine, sulfadoxine-pyrimethamine and artemisinin in southern Viet Nam. Trans R Soc Trop Med Hyg 95 : 513–517. [Google Scholar]
  33. Noedl H, Faiz MA, Yunus EB, Rahman MR, Hossain MA, Samad R, Miller RS, Pang LW, Wongsrichanalai C, 2003. Drug-resistant malaria in Bangladesh: an in vitro assessment. Am J Trop Med Hyg 68 : 140–142. [Google Scholar]
  34. Price RN, Cassar C, Brockman A, Duraisingh M, van Vugt M, White NJ, Nosten F, Krishna S, 1999. The pfmdr1 gene is associated with a multidrug-resistant phenotype in Plasmodium falciparum from the western border of Thailand. Anti-microb Agents Chemother 43 : 2943–2949. [Google Scholar]
  35. Ittarat W, Pickard AL, Rattanasinganchan P, Wilairatana P, Looareesuwan S, Emery K, Low J, Udomsangpetch R, Meshnick SR, 2003. Recrudescence in artesunate-treated patients with falciparum malaria is dependent on parasite burden not on parasite factors. Am J Trop Med Hyg 68 : 147–152. [Google Scholar]
  36. Sokhna CS, Rogier C, Dieye A, Trape JF, 2000. Host factors affecting the delay of reappearance of Plasmodium falciparum after radical treatment among a semi-immune population exposed to intense perennial transmission. Am J Trop Med Hyg 62 : 266–270. [Google Scholar]
  37. ter Kuile FO, Luxemburger C, Nosten F, Thwai KL, Chong-suphajaisiddhi T, White NJ, 1995. Predictors of mefloquine treatment failure: a prospective study of 1590 patients with uncomplicated falciparum malaria. Trans R Soc Trop Med Hyg 89 : 660–664. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2005.73.616
Loading
/content/journals/10.4269/ajtmh.2005.73.616
Loading

Data & Media loading...

  • Received : 04 Feb 2005
  • Accepted : 19 Apr 2005

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error