Pharmacokinetics and pharmacodynamics of intravenous artesunate during severe malaria treatment in Ugandan adults

Malaria Journal

Research

Celestino Obua¹  Peter J de Vries²  Lillian Nabukeera³  Mohammed Lamorde⁴  Concepta Merry⁵  Pauline Byakika-Kibwika⁵  Harriet Mayanja-Kizza⁶  Elly Katabira⁶  Jonathan Mayito⁷  Nadine Pakker⁷  Warunee Hanpithakpong⁸  Niklas Lindegardh⁹  Joel Tarning⁹ 

[1] Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda;Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, Netherlands;Infectious Diseases Institute, Makerere University, P. O. Box 22418, Kampala, Uganda;Infectious Diseases Institute, Makerere University, P. O. Box 22418, Kampala, Uganda;Department of Pharmacology and Therapeutics Trinity College, Dublin, Ireland;Infectious Diseases Institute, Makerere University, P. O. Box 22418, Kampala, Uganda;Department of Pharmacology and Therapeutics Trinity College, Dublin, Ireland;Infectious Diseases Network for Treatment and Research in Africa, Kampala, Uganda;Infectious Diseases Institute, Makerere University, P. O. Box 22418, Kampala, Uganda;Infectious Diseases Network for Treatment and Research in Africa, Kampala, Uganda;Infectious Diseases Network for Treatment and Research in Africa, Kampala, Uganda;Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK;

关键词: Pharmacokinetics;    Pharmacodynamics;    Intravenous;    Artesunate;    Severe malaria;   

DOI  :  10.1186/1475-2875-11-132

 received in 2011-11-29, accepted in 2012-04-27,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundSevere malaria is a medical emergency with high mortality. Prompt achievement of therapeutic concentrations of highly effective anti-malarial drugs reduces the risk of death. The aim of this study was to assess the pharmacokinetics and pharmacodynamics of intravenous artesunate in Ugandan adults with severe malaria.MethodsFourteen adults with severe falciparum malaria requiring parenteral therapy were treated with 2.4 mg/kg intravenous artesunate. Blood samples were collected after the initial dose and plasma concentrations of artesunate and dihydroartemisinin measured by solid-phase extraction and liquid chromatography-tandem mass spectrometry. The study was approved by the Makerere University Faculty of Medicine Research and Ethics Committee (Ref2010-015) and Uganda National Council of Science and Technology (HS605) and registered with ClinicalTrials.gov (NCT01122134).ResultsAll study participants achieved prompt resolution of symptoms and complete parasite clearance with median (range) parasite clearance time of 17 (8–24) hours. Median (range) maximal artesunate concentration (Cmax) was 3260 (1020–164000) ng/mL, terminal elimination half-life (T1/2) was 0.25 (0.1-1.8) hours and total artesunate exposure (AUC) was 727 (290–111256) ng·h/mL. Median (range) dihydroartemisinin Cmax was 3140 (1670–9530) ng/mL, with Tmax of 0.14 (0.6 – 6.07) hours and T1/2 of 1.31 (0.8–2.8) hours. Dihydroartemisinin AUC was 3492 (2183–6338) ng·h/mL. None of the participants reported adverse events.ConclusionsPlasma concentrations of artesunate and dihydroartemisinin were achieved rapidly with rapid and complete symptom resolution and parasite clearance with no adverse events.

【 授权许可】

CC BY   
© Byakika-Kibwika et al.; licensee BioMed Central Ltd. 2012