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- Title
Changes in the Treatment Responses to Artesunate- Mefloquine on the Northwestern Border of Thailand during 13 Years of Continuous Deployment.
- Authors
Carrara, Verena Ilona; Zwang, Julien; Ashley, Elizabeth A.; Price, Ric N.; Stepniewska, Kasia; Barends, Marion; Brockman, Alan; Anderson, Tim; McGready, Rose; Phaiphun, Lucy; Proux, Stephane; van Vugt, Michele; Hutagalung, Robert; Lwin, Khin Maung; Phyo, Aung Pyae; Preechapornkul, Piyanuch; Imwong, Mallika; Pukrittayakamee, Sasithon; Singhasivanon, Pratap; White, Nicholas J.
- Abstract
Background: Artemisinin combination treatments (ACT) are recommended as first line treatment for falciparum malaria throughout the malaria affected world. We reviewed the efficacy of a 3-day regimen of mefloquine and artesunate regimen (MAS3), over a 13 year period of continuous deployment as first-line treatment in camps for displaced persons and in clinics for migrant population along the Thai-Myanmar border. Methods and Findings: 3,264 patients were enrolled in prospective treatment trials between 1995 and 2007 and treated with MAS3. The proportion of patients with parasitaemia persisting on day-2 increased significantly from 4.5% before 2001 to 21.9% since 2002 (p,0.001). Delayed parasite clearance was associated with increased risk of developing gametocytaemia (AOR = 2.29; 95% CI, 2.00-2.69, p = 0.002). Gametocytaemia on admission and carriage also increased over the years (p = 0.001, test for trend, for both). MAS3 efficacy has declined slightly but significantly (Hazards ratio 1.13; 95% CI, 1.07-1.19, p,0.001), although efficacy in 2007 remained well within acceptable limits: 96.5% (95% CI, 91.0-98.7). The in vitro susceptibility of P. falciparum to artesunate increased significantly until 2002, but thereafter declined to levels close to those of 13 years ago (geometric mean in 2007: 4.2 nM/l; 95% CI, 3.2-5.5). The proportion of infections caused by parasites with increased pfmdr1 copy number rose from 30% (12/40) in 1996 to 53% (24/45) in 2006 (p = 0.012, test for trend). Conclusion: Artesunate-mefloquine remains a highly efficacious antimalarial treatment in this area despite 13 years of widespread intense deployment, but there is evidence of a modest increase in resistance. Of particular concern is the slowing of parasitological response to artesunate and the associated increase in gametocyte carriage.
- Subjects
THAILAND; MALARIA treatment; MEFLOQUINE; ARTEMISININ; DISEASE risk factors; GEOMETRIC analysis; PARASITOLOGY
- Publication
PLoS ONE, 2009, Vol 4, Issue 2, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0004551