Simple jQuery Dropdowns
Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/31056
Title: Reduced Susceptibility of Plasmodium falciparum to Artesunate in Southern Myanmar
Authors: Myat P. Kyaw
Myat H. Nyunt
Khin Chit
Moe M. Aye
Kyin H. Aye
Moe M. Aye
Niklas Lindegardh
Joel Tarning
Mallika Imwong
Christopher G. Jacob
Charlotte Rasmussen
Jamie Perin
Pascal Ringwald
Myaing M. Nyunt
Department of Medical Research (Lower Myanmar)
Mahidol University
Nuffield Department of Clinical Medicine
University of Maryland School of Medicine
Organisation Mondiale de la Sante
Johns Hopkins Bloomberg School of Public Health
The Johns Hopkins School of Medicine
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 8-Mar-2013
Citation: PLoS ONE. Vol.8, No.3 (2013)
Abstract: Background: Plasmodium falciparum resistance to artemisinins, the first line treatment for malaria worldwide, has been reported in western Cambodia. Resistance is characterized by significantly delayed clearance of parasites following artemisinin treatment. Artemisinin resistance has not previously been reported in Myanmar, which has the highest falciparum malaria burden among Southeast Asian countries. Methods: A non-randomized, single-arm, open-label clinical trial of artesunate monotherapy (4 mg/kg daily for seven days) was conducted in adults with acute blood-smear positive P. falciparum malaria in Kawthaung, southern Myanmar. Parasite density was measured every 12 hours until two consecutive negative smears were obtained. Participants were followed weekly at the study clinic for three additional weeks. Co-primary endpoints included parasite clearance time (the time required for complete clearance of initial parasitemia), parasite clearance half-life (the time required for parasitemia to decrease by 50% based on the linear portion of the parasite clearance slope), and detectable parasitemia 72 hours after commencement of artesunate treatment. Drug pharmacokinetics were measured to rule out delayed clearance due to suboptimal drug levels. Results: The median (range) parasite clearance half-life and time were 4.8 (2.1-9.7) and 60 (24-96) hours, respectively. The frequency distributions of parasite clearance half-life and time were bimodal, with very slow parasite clearance characteristic of the slowest-clearing Cambodian parasites (half-life longer than 6.2 hours) in approximately 1/3 of infections. Fourteen of 52 participants (26.9%) had a measurable parasitemia 72 hours after initiating artesunate treatment. Parasite clearance was not associated with drug pharmacokinetics. Conclusions: A subset of P. falciparum infections in southern Myanmar displayed markedly delayed clearance following artemisinin treatment, suggesting either emergence of artemisinin resistance in southern Myanmar or spread to this location from its site of origin in western Cambodia. Resistance containment efforts are underway in Myanmar. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12610000896077. © 2013 Kyaw et al.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84874787941&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/31056
ISSN: 19326203
Appears in Collections:Scopus 2011-2015

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.