Monitoring for Plasmodium falciparum drug resistance to artemisinin and artesunate in Binh Phuoc Province, Vietnam: 1998-2009

Malaria Journal

Research

Gerard J Casey¹  Beverley-Ann Biggs²  Tran Q Toan³  Nguyen M Hung³  Nong T Tien³  Ngo V Thanh³  Bui Q Phuc³  Alan F Cowman⁴ 

[1] Department of Medicine (RMH/WH), The University of Melbourne, 4th Floor Clinical Sciences Building, The Royal Melbourne Hospital, 3050, Parkville, Victoria, Australia;Department of Medicine (RMH/WH), The University of Melbourne, 4th Floor Clinical Sciences Building, The Royal Melbourne Hospital, 3050, Parkville, Victoria, Australia;Victorian Infectious Diseases Service and Centre of Clinical Research Excellence in Infectious Diseases (CCREID), The Royal Melbourne Hospital, 3050, Parkville, Victoria, Australia;National Institute of Malariology Parasitology and Entomology, Hanoi, Vietnam;Walter and Eliza Hall Institute for Medical Research, 3050, Parkville, Victoria, Australia;

关键词: Malaria;    Mefloquine;    Falciparum Malaria;    Artesunate;    Artemether;   

DOI  :  10.1186/1475-2875-9-181

 received in 2010-03-15, accepted in 2010-06-24,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundArtemisinin derivatives have been used for malaria treatment in Vietnam since 1989. Reported malaria cases have decreased from 1,672,000 with 4,650 deaths in 1991, to 91,635 with 43 deaths in 2006. Current national guidelines recommend artemisinin-based combination therapy (ACT), although artesunate is still available as monotherapy through the private sector. Recent reports suggest that effectiveness of ACT and artesunate monotherapy has declined in western Cambodia. This study examined Plasmodium falciparum resistance patterns over 10 years in southwest Vietnam in infected patients treated with artemisinin compounds.MethodsThe study was conducted in two communes in Phuoc Long district, Binh Phuoc province, 100 km west of the Cambodian border. This was chosen as a likely site for emerging artemisinin resistance because of the high prevalence of P. falciparum malaria, and the length of time that artemisinin had been in use. In vivo and in vitro monitoring of P. falciparum susceptibility to anti-malarial drugs was conducted in 1998, 2001, 2004/5, and 2008/9. Patients with confirmed P. falciparum malaria received therapy with 5 or 7 days of artemisinin (1998 and 2001 respectively) or 7 days of artesunateResultsIn the four surveys, 270 patients were recruited and treated. The mean parasite clearance times differed between 1998, 2001 and 2004/5 (1.8, 2.3 and 2.1 days, P < 0.01) but not between 1998 and 2008/2009. The mean parasite clearance times were correlated with parasite density at day 0 (r = 0.4; P < 0.001). Treatment failure rates after PCR adjustment were 13.8%, 2.9%, 1.2%, and 0% respectively. Susceptibility of P. falciparum to artemisinin in in vitro tests was stable during the period, except for a rise in EC90 and EC99 in 2001.ConclusionsThis study showed stable levels of P. falciparum sensitivity to artemisinin compounds in the two sites over a ten-year period. The introduction of ACT in this area in 2003 may have protected against the development of artemisinin resistance. Adherence to the latest WHO and Vietnamese guidelines, which recommend ACT as first-line therapy in all malarious areas, and continued monitoring along the Vietnam-Cambodia border will be essential to prevent the spread of artemisinin resistance in Vietnam.

【 授权许可】

Unknown   
© Thanh et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.