In Vivo Parasitological Measures of Artemisinin Susceptibility
Stepniewska, Kasia ; Ashley, Elizabeth ; Lee, Sue J. ; Anstey, Nicholas ; Barnes, Karen I. ; Binh, Tran Quang ; 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 ; White, Nicholas J.
In: The Journal of Infectious Diseases, 2010, vol. 201, no. 4, p. 570-579
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- 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/µL 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