Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/27052
Title: Changes in the treatment responses to artesunate-mefloquine on the northwestern border of Thailand during 13 years of continuous deployment
Authors: Verena Ilona Carrara
Julien Zwang
Elizabeth A. Ashley
Ric N. Price
Kasia Stepniewska
Marion Barends
Alan Brockman
Tim Anderson
Rose McGready
Lucy Phaiphun
Stephane Proux
Michele van Vugt
Robert Hutagalung
Khin Maung Lwin
Aung Pyae Phyo
Piyanuch Preechapornkul
Mallika Imwong
Sasithon Pukrittayakamee
Pratap Singhasivanon
Nicholas J. White
François Nosten
Shoklo Malaria Research Unit
Mahidol University
Churchill Hospital
Menzies School of Health Research
Texas Biomedical Research Institute
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 23-Feb-2009
Citation: PLoS ONE. Vol.4, No.2 (2009)
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). MAS3efficacy 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. © 2009 Carrara et al.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84858449712&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/27052
ISSN: 19326203
Appears in Collections:Scopus 2006-2010

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.