Characterization of “Yaa Chud” Medicine on the Thailand–Myanmar Border: Selecting for Drug-resistant Malaria and Threatening Public Health

Paul N. Newton Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Christina Y. Hampton Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Krystyn Alter-Hall Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Thanongsak Teerwarakulpana Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Sompol Prakongpan Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Ronnatrai Ruangveerayuth Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Nicholas J. White Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Nicholas P. J. Day Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Mabel B. Tudino Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Natalia Mancuso Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Facundo M. Fernández Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Multidrug-resistant Plasmodium falciparum malaria is a severe public health problem on the Thailand–Myanmar border. Many villagers buy packets of 4–5 mixed medicines (“yaa chud”) from shops without medical assessment as their first-line malaria treatment. In 2000–2001 a local researcher purchased 50 yaa chud from 44 shops around Mae Sot, Thailand and Myawaddy, Myanmar (Burma), for his wife who was said to be pregnant with fever and drowsiness. The tablets/capsules were provisionally identified by appearance and active ingredients determined in a subset by using mass and atomic spectrometry. The most frequently detected active ingredients were acetaminophen (22%), chlorpheniramine (13.4%), chloroquine (12.6%), tetracycline/doxycycline (11.4%), and quinine (5.1%). Only seven bags contained potentially curative medicine for malaria. A total of 82% of the bags contained medicines contraindicated in pregnancy. Inappropriate, ineffective antimalarial drugs on the Thailand–Myanmar border are likely to increase malaria morbidity, mortality and health costs and engender the emergence and spread of antimalarial drug resistance.

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