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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Effect of high-dose or split-dose artesunate on parasite clearance in artemisinin-resistant falciparum malaria
Clinical Infectious Diseases, Volume 56, No. 5, Year 2013
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Description
Background. The emergence of Plasmodium falciparum resistance to artemisinins on the Cambodian and Myanmar-Thai borders poses severe threats to malaria control. We investigated whether increasing or splitting the dose of the short-half-life drug artesunate improves parasite clearance in falciparum malaria in the 2 regions.Methods. In Pailin, western Cambodia (from 2008 to 2010), and Wang Pha, northwestern Thailand (2009-2010), patients with uncomplicated falciparum malaria were randomized to oral artesunate 6 mg/kg/d as a once-daily or twice-daily dose for 7 days, or artesunate 8 mg/kg/d as a once-daily or twice-daily dose for 3 days, followed by mefloquine. Parasite clearance and recrudescence for up to 63 days of follow-up were assessed.Results. A total of 159 patients were enrolled. Overall median (interquartile range [IQR]) parasitemia half-life (half-life) was 6.03 (4.89-7.28) hours in Pailin versus 3.42 (2.20-4.85) hours in Wang Pha (P =. 0001). Splitting or increasing the artesunate dose did not shorten half-life in either site. Pharmacokinetic profiles of artesunate and dihydroartemisinin were similar between sites and did not correlate with half-life. Recrudescent infections occurred in 4 of 79 patients in Pailin and 5 of 80 in Wang Pha and was not different between treatment arms (P =. 68).Conclusions. Increasing the artesunate treatment dose up to 8 mg/kg/d or splitting the dose does not improve parasite clearance in either artemisinin resistant or more sensitive infections with P. falciparum.Clinical Trials Registration. ISRCTN15351875. © 2012 The Author.
Authors & Co-Authors
Das, Debashish
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
Worldwide Antimalarial Resistance Network
Tripura, Rupam
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
Pyae Phyo, Aung Pyae P.
Thailand, Mae Sod
Shoklo Malaria Research Unit
Lwin, K. M.
Thailand, Mae Sod
Shoklo Malaria Research Unit
Tarning, Joel
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Lee, Sue J.
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Hanpithakpong, Warunee
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
Stepniewska, K. A.
United Kingdom, Oxford
University of Oxford
United Kingdom, Oxford
Worldwide Antimalarial Resistance Network
Menard, Didier
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Ringwald, Pascal
Switzerland, Geneva
Organisation Mondiale de la Santé
Silamut, Kamolrat
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
Imwong, Mallika
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
Chotivanich, Kesinee T.
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
Yi, Poravuth
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Day, Nichloas P.J.
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Lindegårdh, Niklas
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Socheat, Duong
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Nguon, Chea
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
White, Nicholas J.
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Nosten, François Henry
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
Thailand, Mae Sod
Shoklo Malaria Research Unit
United Kingdom, Oxford
University of Oxford
Dondorp, A. M.
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Statistics
Citations: 46
Authors: 21
Affiliations: 7
Identifiers
Doi:
10.1093/cid/cis958
ISSN:
15376591
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study