A Randomized Controlled Pilot Study of Artesunate versus Triclabendazole for Human Fascioliasis in Central Vietnam

Tran Tinh Hien Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Ng Thanh Truong Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Nguyen Hoang Minh Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Hoang Dinh Dat Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Nguyen Thi Dung Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Nguyen Thi Hue Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Tran Kim Dung Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Phung Quoc Tuan Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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James I. Campbell Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Jeremy J. Farrar Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Jeremy N. Day Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, United Kingdom; Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom

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Human fascioliasis caused by Fasciola hepatica or Fasciola gigantica is an increasing global problem. The mainstay of current treatment is triclabendazole, but resistance in animals has been described, and it is not available in many countries. The antimalarial artesunate has an excellent safety profile, and there is increasing evidence of its efficacy against other parasites both in vitro and in vivo. We performed a study to investigate the usefulness of artesunate in symptomatic human fascioliasis; 100 patients were enrolled. Patients treated with artesunate were significantly more likely to be free of abdominal pain at hospital discharge (50/50 versus 44/50, P = 0.027, relative risk 1.14, 95% confidence interval 1.03–1.26), but the complete response rate at 3 months was lower than for patients treated with triclabendazole (38/50 versus 46/50, P = 0.05, RR 0.83, 95% CI 0.69–0.98, artesunate versus triclabendazole). There may be a role for artesunate in fascioliasis.

Author Notes

Reprint requests: Jeremy N. Day, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam, Telephone: +84 8923 7954, Fax: +84 8923 8904, E-mail: jday@oucru.org.
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