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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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    Title
    • In Vivo Parasitological Measures of Artemisinin Susceptibility
    Author
    • Stepniewska, Kasia. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok
    • Ashley, Elizabeth. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok
    • Lee, Sue J.. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok
    • Anstey, Nicholas. Menzies School of Health Research and Royal Darwin HospitalDarwin, Australia
    • Barnes, Karen I.. Division of Clinical Pharmacology, Department of Medicine, University of Cape TownCape Town, South Africa
    • Binh, Tran Quang. Cho Ray HospitalHo Chi Minh City, Vietnam
    • D'Alessandro, Umberto. Institute of Tropical MedicineAntwerp, Belgium
    • Day, Nicholas P. J.. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok
    • de Vries, Peter J.. Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical CenterAmsterdam, the Netherlands
    • Dorsey, Grant. University of CaliforniaSan Francisco
    • Guthmann, Jean-Paul. EpicentreParis
    • Mayxay, Mayfong. National University, Microbiology Laboratory, Mahost HospitalVientiane, Lao People's Democratic Republic
    • Newton, Paul N.. Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahost HospitalVientiane, Lao People's Democratic Republic
    • Olliaro, Piero. Centre for Tropical Medicine, University of OxfordOxford
    • Osorio, Lyda. Centro Internacional de Entrenamiento e Investigaciones MedicasCali, Colombia
    • Price, Ric N.. Menzies School of Health Research and Royal Darwin HospitalDarwin, Australia
    • Rowland, Mark. London School of Hygiene and Tropical MedicineLondon, United Kingdom
    • Smithuis, Frank. Médecins Sans FrontièresHolland (Artsen Zonder Grenzen), Myanmar
    • Taylor, Walter R. J.. World Health Organization Special Programme on Research and Training in Tropical Diseases (TDR), Hopitaux Universitaires de GenèveGeneva, Switzerland
    • Nosten, François. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok
    • White, Nicholas J.. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok
    Document Type
    • Postprint
    Language
    • English
    Published in
    • The Journal of Infectious Diseases, 2010, vol. 201, no. 4, p. 570-579. The University of Chicago Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:291595
    Summary
    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