In Vivo Parasitological Measures of Artemisinin Susceptibility


Stepniewska, K; Ashley, E; Lee, SJ; Anstey, N; Barnes, KI; Tran, QB; D'Alessandro, U; Day, NPJ; de Vries, PJ; Dorsey, G; Guthmann, JP; Mayxay, M; Newton, PN; Olliaro, P; Osorio, L; Price, RN; Rowland, M; Smithuis, F; Taylor, WRJ; Nosten, F; White, NJ; (2010) In Vivo Parasitological Measures of Artemisinin Susceptibility. The Journal of infectious diseases, 201 (4). pp. 570-579. ISSN 0022-1899 DOI: https://doi.org/10.1086/650301

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Abstract

Parasite clearance data from 18,699 patients with falciparum malaria treated with an artemisinin derivative in areas of low (n = 14,539), moderate (n = 2077), and high (n = 2083) levels of malaria transmission across the world were analyzed to determine the factors that affect clearance rates and identify a simple in vivo screening measure for artemisinin resistance. The main factor affecting parasite clearance time was parasite density on admission. Clearance rates were faster in high-transmission settings and with more effective partner drugs in artemisinin-based combination treatments (ACTs). The result of the malaria blood smear on day 3 (72 h) was a good predictor of subsequent treatment failure and provides a simple screening measure for artemisinin resistance. Artemisinin resistance is highly unlikely if the proportion of patients with parasite densities of <100,000 parasites/mu L given the currently recommended 3-day ACT who have a positive smear result on day 3 is <3%; that is, for n patients the observed number with a positive smear result on day 3 does not exceed. (n + 60)/24.

Item Type: Article
Keywords: plasmodium-falciparum malaria, artesunate-mefloquine combination, antimalarial-drugs, pharmacodynamic properties, parasite clearance, resistant malaria, thailand, efficacy, cambodia, border, Adolescent, Adult, Aged, Aged, 80 and over, Antimalarials, therapeutic use, Artemisinins, therapeutic use, Child, Child, Preschool, Drug Resistance, Endemic Diseases, Humans, Infant, Kaplan-Meiers Estimate, Malaria, Falciparum, drug therapy, epidemiology, parasitology, transmission, Middle Aged, Parasitemia, drug therapy, epidemiology, parasitology, transmission, Plasmodium falciparum, drug effects, Recurrence
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
PubMed ID: 20085495
Web of Science ID: 273843900014
URI: http://researchonline.lshtm.ac.uk/id/eprint/3861

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