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No Evidence of Delayed Parasite Clearance after Oral Artesunate Treatment of Uncomplicated Falciparum Malaria in Mali
Plasmodium falciparum resistance to artemisinins by delayed parasite clearance is present in Southeast Asia. Scant data on parasite clearance after artemisinins are available from Africa, where transmission is high, burden is greatest, and artemisinin use is being scaled up. Children 1–10 years of age with uncomplicated malaria were treated with 7 days of artesunate and followed for 28 days. Blood smears were done every 8 hours until negative by light microscopy. Results were compared with a similar study conducted in the same village in 2002–2004. The polymerase chain reaction-corrected cure rate was 100%, identical to 2002–2004. By 24 hours after treatment initiation, 37.0% of participants had cleared parasitemia, compared with 31.9% in 2002–2004 (P = 0.5). The median parasite clearance time was 32 hours. Only one participant still had parasites at 48 hours and no participant presented parasitemia at 72 hours. Artesunate was highly efficacious, with no evidence of delayed parasite clearance. We provide baseline surveillance data for the emergence or dissemination of P. falciparum resistance in sub-Saharan Africa.
Author Notes
Financial support: This study was primarily funded by the European and Developing Countries Clinical Trials Partnership (EDCTP IP_07_31060_002) and by the West African Network for Clinical Trials of Antimalarial Drugs (WANECAM). This work was also supported by the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental and Craniofacial Research, National Institute On Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases Health, and NIH Office of Women's Health and Research through the International Clinical Research Scholars and Fellows Program at Vanderbilt University (R24 TW007988) and the American Relief and Recovery Act.
Authors' addresses: Amelia W. Maiga, Duke University School of Medicine, Durham, NC, E-mail: aw70@duke.edu. Bakary Fofana, Issaka Sagara, Demba Dembele, Antoine Dara, Oumar Bila Traore, Sekou Toure, Kassim Sanogo, Souleymane Dama, Bakary Sidibe, Aminatou Kone, Mahamadou A. Thera, Ogobara K. Doumbo, and Abdoulaye A. Djimde, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy, and Odonto-stomatology, University of Bamako, Bamako, Mali, E-mails: bfofana@icermali.org, isagara@icermali.org, ddembele@icermali.org, tonydara@icermali.org, bila@icermali.org, sekout@icermali.org, sanogok@icermali.org, dama@icermali.org, bakary@icermali.org, amina@icermali.org, mthera@icermali.org, okd@icermali.org, and adjimde@icermali.org. Christopher V. Plowe, Center for Vaccine Development Howard Hughes Medical Institute, University of Maryland School of Medicine, Baltimore, MD, E-mail: cplowe@medicine.umaryland.edu.