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

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2005-09-01
2017-09-20
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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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  19. Lee IS, Hufford CD, 1990. Metabolism of antimalarial sesquiterpene lactones. Pharmacol Ther 48 : 345–355.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
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  • Received : 04 Feb 2005
  • Accepted : 19 Apr 2005

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