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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
In vivo susceptibility of plasmodium falciparum to artesunate in Binh Phuoc Province, Vietnam
Malaria Journal, Volume 11, Article 355, Year 2012
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Description
Background: By 2009, there were worrying signs from western Cambodia that parasitological responses to artesunate-containing treatment regimens for uncomplicated Plasmodium falciparum malaria were slower than elsewhere which suggested the emergence of artemisinin resistance. Vietnam shares a long land border with Cambodia with a large number of migrants crossing it on a daily basis. Therefore, there is an urgent need to investigate whether there is any evidence of a change in the parasitological response to the artemisinin derivatives in Vietnam. Methods. From August 2010 to May 2011, a randomized controlled clinical trial in uncomplicated falciparum malaria was conducted to compare two doses of artesunate (AS) (2mg/kg/day versus 4 mg/kg/day for three days) followed by dihydroartemisinin-piperaquine (DHA-PPQ) and a control arm of DHA-PPQ. The goal was characterization of the current efficacy of artesunate in southern Vietnam. The primary endpoint of this study was the parasite clearance half-life; secondary endpoints included the parasite reduction ratios at 24 and 48 hours and the parasite clearance time. Results: 166 patients were recruited into the study. The median parasite clearance half-lives were 3.54 (AS 2mg/kg), 2.72 (AS 4mg/kg), and 2.98 hours (DHA-PPQ) (p=0.19). The median parasite-reduction ratio at 24 hours was 48 in the AS 2mg/kg group compared with 212 and 113 in the other two groups, respectively (p=0.02). The proportions of patients with a parasite clearance time of >72 hours for AS 2mg/kg, AS 4mg/kg and DHA-PPQ were 27%, 27%, and 22%, respectively. Early treatment failure occurred in two (4%) and late clinical failure occurred in one (2%) of the 55 patients in the AS 2mg/kg group, as compared with none in the other two study arms. The PCR-corrected adequate clinical and parasitological response (APCR) rates in the three groups were 94%, 100%, and 100% (p=0.04). Conclusions: This study demonstrated faster P. falciparum parasite clearance in southern Vietnam than in western Cambodia but slower clearance in comparison with historical data from Vietnam. Further studies to determine whether this represents the emergence of artemisinin resistance in this area are needed. Currently, the therapeutic response to DHA-PPQ remains satisfactory in southern Vietnam. © 2012 Hien et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Hien, Tran Tinh
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
University of Oxford
Thuy-Nhien, Nguyen Thanh
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
Phu, Nguyen Hoan
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
Boni, Maciej F.
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
University of Oxford
Thanh, Ngo Viet
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
Thai, Cao Quang
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
Dong, Lethanh
Unknown Affiliation
Merson, Laura
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
University of Oxford
Dolecek, Christiane
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
University of Oxford
Stepniewska, K. A.
United Kingdom, Oxford
University of Oxford
Ringwald, Pascal
Switzerland, Geneva
Organisation Mondiale de la Santé
White, Nicholas J.
Thailand, Nakhon Pathom
Mahidol University
United Kingdom, Oxford
University of Oxford
Farrar, Jeremy James
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
University of Oxford
Wolbers, Marcel
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
United Kingdom, Oxford
University of Oxford
Statistics
Citations: 112
Authors: 14
Affiliations: 5
Identifiers
Doi:
10.1186/1475-2875-11-355
ISSN:
14752875
Research Areas
Infectious Diseases