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- Title
In Vivo Parasitological Measures of Artemisinin Susceptibility.
- Authors
Stepniewska, Kasia; Ashley, Elizabeth; Lee, Sue J.; Anstey, Nicholas; Barnes, Karen I.; Tran Quang Binh; D'Alessandro, Umberto; Day, Nicholas P. J.; de Vries, Peter J.; Dorsey, Grant; Guthmann, Jean-Paul; Mayxay, Mayfong; Newton, Paul N.; Olliaro, Piero; Osorio, Lyda; Price, Ric N.; Rowland, Mark; Smithuis, Frank; Taylor, Walter R. J.; Nosten, François
- Abstract
Parasite clearance data from 18,699 patients with falciparum malaria treated with an artemisinin derivative in areas of low (n=14,539), moderate (n=2077), and high (n=2083) levels of malaria transmission across the world were analyzed to determine the factors that affect clearance rates and identify a simple in vivo screening measure for artemisinin resistance. The main factor affecting parasite clearance time was parasite density on admission. Clearance rates were faster in high-transmission settings and with more effective partner drugs in artemisinin-based combination treatments (ACTs). The result of the malaria blood smear on day 3 (72 h) was a good predictor of subsequent treatment failure and provides a simple screening measure for artemisinin resistance. Artemisinin resistance is highly unlikely if the proportion of patients with parasite densities of <100,000 parasites/mL given the currently recommended 3-day ACT who have a positive smear result on day 3 is <3%; that is, for n patients the observed number with a positive smear result on day 3 does not exceed (n + 60)/24.
- Subjects
ARTEMISININ; ANTIMALARIALS; MALARIA transmission; MULTIDRUG resistance; CHLOROQUINE; MEDICAL screening; PARASITOLOGY; CLINICAL trials; CLINICAL medicine research
- Publication
Journal of Infectious Diseases, 2010, Vol 201, Issue 4, p570
- ISSN
0022-1899
- Publication type
Article
- DOI
10.1086/650301