Details:

Alternative Title:
Malar J
Personal Author:
Vijaykadga, Saowanit ; Alker, Alisa P ; Satimai, Wichai ; MacArthur, John R ; Meshnick, Steven R ; ... More +
Vijaykadga, Saowanit ; Alker, Alisa P ; Satimai, Wichai ; MacArthur, John R ; Meshnick, Steven R ; Wongsrichanalai, Chansuda Less -
Description:
Background

There 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.

Methods

This 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.

Results

The 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.

Discussion

Delayed 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.


Subjects:
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Adolescent Adult Aged Aged, 80 And Over Antimalarials Artemisinins Child Child, Preschool Drug Resistance Drug Therapy, Combination Female Humans Malaria, Falciparum Male Mefloquine Middle Aged Parasitemia Plasmodium Falciparum Retrospective Studies Time Factors Treatment Outcome Young Adult
Source:
Malar J. 2012; 11:296.
Document Type:
Journal Article
Place as Subject:
Thailand
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:ed9b382e0551b07f3c23d79d0721c40d3962e4b0cab18124e03ad29bbbd7103b
Download URL:
https://stacks.cdc.gov/view/cdc/10988/cdc_10988_DS1.pdf
File Type:

Supporting Files

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