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Title: In vivo parasitological measures of artemisinin susceptibility
Authors: Kasia Stepniewska
Elizabeth Ashley
Sue J. Lee
Nicholas Anstey
Karen I. Barnes
Tran Quang Binh
Umberto D'Alessandro
Nicholas P.J. Day
Peter J. De Vries
Grant Dorsey
Jean Paul Guthmann
Mayfong Mayxay
Paul N. Newton
Piero Olliaro
Lyda Osorio
Rie N. Price
Mark Rowland
Frank Smithuis
Walter R.J. Taylor
François Nosten
Nicholas J. White
Mahidol University
Shoklo Malaria Research Unit
Menzies School of Health Research
University of Cape Town
Cho Ray Hospital
Prins Leopold Instituut voor Tropische Geneeskunde
University of Oxford
London School of Hygiene & Tropical Medicine
Academic Medical Centre, University of Amsterdam
University of California, San Francisco
Institut de Recherche en Sciences de la Santé
Uganda Malaria Surveillance Program
Institut de Veille Sanitaire
National University of Laos
Oxford University Tropical Medicine Research Collaboration
Organisation Mondiale de la Sante
Hopitaux universitaires de Geneve
Centra Internacional de Entrenamiento e Investigaciones Medicas
Imperial College Healthcare NHS Trust
Keywords: Medicine
Issue Date: 15-Feb-2010
Citation: Journal of Infectious Diseases. Vol.201, No.4 (2010), 570-579
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//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. © 2010 by the Infectious Diseases Society of America. All rights reserved.
ISSN: 00221899
Appears in Collections:Scopus 2006-2010

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