Delayed Plasmodium falciparum clearance following artesunate-mefloquine combination therapy in Thailand, 1997–2007

Malaria Journal

Research

Saowanit Vijaykadga¹  Wichai Satimai¹  Steven R Meshnick²  Alisa P Alker³  Chansuda Wongsrichanalai⁴  John R MacArthur⁵ 

[1] Bureau of Vector Borne Diseases, Department of Diseases Control, Ministry of Public Health, Nonthaburi, Thailand;Department of Epidemiology, Gilings School of Public Health, University of North Carolina, Chapel Hill, NC, USA;Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA;US Agency for International Development Regional Development Mission for Asia (USAID/RDMA), Bangkok, Thailand;US Agency for International Development Regional Development Mission for Asia (USAID/RDMA), Bangkok, Thailand;Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

关键词: Malaria;    drug resistance;    parasite clearance;   

DOI  :  10.1186/1475-2875-11-296

 received in 2012-05-24, accepted in 2012-08-20,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThere is concern that artesunate resistance is developing in Southeast Asia. The purpose of this study is to investigate the prevalence of parasitaemia in the few days following treatment with artesunate-mefloquine (AM), which is an indirect measure of decreased artesunate susceptibility.MethodsThis is a retrospective analysis of 31 therapeutic efficacy studies involving 1,327 patients treated with AM conducted by the Thai National Malaria Control Programme from 1997–2007.ResultsThe prevalence of patients with parasitaemia on day 2 was higher in the east compared to the west (east: 20%, west: 9%, OR 2.47, 95% CI: 1.77, 3.45). In addition, the prevalence of day-2 parasitaemia increased over time (OR for each year = 1.10, 95% CI: 1.03, 1.19). After controlling for initial parasitaemia and age, year and region remained important determinants of day-2 parasitaemia (OR for region = 3.98, 95%CI 2.63, 6.00; OR for year = 1.28, 95%CI: 1.17, 1.39). The presence of parasitaemia on day 2 and day 3 were specific, but not sensitive predictors of treatment failure.DiscussionDelayed resolution of parasitaemia after AM treatment increased in eastern Thailand between 1997 and 2007, which may be an early manifestation of decreased artesunate susceptibility. However, clinical and parasitological treatment failure after 28 days (which is related to both mefloquine and artesunate decreased susceptibility) is not changing over time. The presence of parasitaemia on day 2 is a poor indicator of AM 28-day treatment failure.

【 授权许可】

Unknown   
© Vijaykadga et al.; licensee BioMed Central Ltd. 2012. 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.