Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
general
Reduced Susceptibility of Plasmodium falciparum to Artesunate in Southern Myanmar
PLoS ONE, Volume 8, No. 3, Article e57689, Year 2013
Notification
URL copied to clipboard!
Description
Background: Plasmodium falciparum resistance to artemisinins, the first line treatment for malaria worldwide, has been reported in western Cambodia. Resistance is characterized by significantly delayed clearance of parasites following artemisinin treatment. Artemisinin resistance has not previously been reported in Myanmar, which has the highest falciparum malaria burden among Southeast Asian countries. Methods: A non-randomized, single-arm, open-label clinical trial of artesunate monotherapy (4 mg/kg daily for seven days) was conducted in adults with acute blood-smear positive P. falciparum malaria in Kawthaung, southern Myanmar. Parasite density was measured every 12 hours until two consecutive negative smears were obtained. Participants were followed weekly at the study clinic for three additional weeks. Co-primary endpoints included parasite clearance time (the time required for complete clearance of initial parasitemia), parasite clearance half-life (the time required for parasitemia to decrease by 50% based on the linear portion of the parasite clearance slope), and detectable parasitemia 72 hours after commencement of artesunate treatment. Drug pharmacokinetics were measured to rule out delayed clearance due to suboptimal drug levels. Results: The median (range) parasite clearance half-life and time were 4.8 (2.1-9.7) and 60 (24-96) hours, respectively. The frequency distributions of parasite clearance half-life and time were bimodal, with very slow parasite clearance characteristic of the slowest-clearing Cambodian parasites (half-life longer than 6.2 hours) in approximately 1/3 of infections. Fourteen of 52 participants (26.9%) had a measurable parasitemia 72 hours after initiating artesunate treatment. Parasite clearance was not associated with drug pharmacokinetics. Conclusions: A subset of P. falciparum infections in southern Myanmar displayed markedly delayed clearance following artemisinin treatment, suggesting either emergence of artemisinin resistance in southern Myanmar or spread to this location from its site of origin in western Cambodia. Resistance containment efforts are underway in Myanmar. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12610000896077. © 2013 Kyaw et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s001.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s002.tiff
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s003.tiff
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s004.tiff
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s005.tiff
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s006.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC3592920/bin/pone.0057689.s007.doc
Authors & Co-Authors
Kyaw, Myat Phone
Unknown Affiliation
Nyunt, Myat Htut
Unknown Affiliation
Aye, Kay Hla
Unknown Affiliation
Lindegårdh, Niklas
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Tarning, Joel
Thailand, Bangkok
Mahidol Oxford Tropical Medicine Research Unit
United Kingdom, Oxford
University of Oxford
Imwong, Mallika
Thailand, Nakhon Pathom
Mahidol University
Jacob, Christopher G.
United States, Chevy Chase
Howard Hughes Medical Institute
Rasmussen, Charlotte
Switzerland, Geneva
Organisation Mondiale de la Santé
Perin, Jamie
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Ringwald, Pascal
Switzerland, Geneva
Organisation Mondiale de la Santé
Nyunt, Myaing Myaing
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
United States, Baltimore
Johns Hopkins School of Medicine
Statistics
Citations: 171
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0057689
ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Quasi Experimental Study