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Title: Poor response to artesunate treatment in two patients with severe malaria on the Thai-Myanmar border
Authors: Aung Pyae Phyo
Kyaw Kyaw Win
Aung Myint Thu
Lei Lei Swe
Htike Htike
Candy Beau
Kanlaya Sriprawat
Markus Winterberg
Stephane Proux
Mallika Imwong
Elizabeth A. Ashley
Francois Nosten
Mahidol University
Nuffield Department of Clinical Medicine
Mae Tao Clinic
Myanmar Oxford Clinical Research Unit
Keywords: Immunology and Microbiology;Medicine
Issue Date: 15-Jan-2018
Citation: Malaria Journal. Vol.17, No.1 (2018)
Abstract: © 2018 The Author(s). Background: Malaria has declined dramatically along the Thai-Myanmar border in recent years due to malaria control and elimination programmes. However, at the same time, artemisinin resistance has spread, raising concerns about the efficacy of parenteral artesunate for the treatment of severe malaria. Case presentation: In November 2015 and April 2017, two patients were treated for severe malaria with parenteral artesunate. Quinine was added within 24 h due to an initial poor response to treatment. The first patient died within 24 h of starting treatment and the second did not clear his peripheral parasitaemia until 11 days later. Genotyping revealed artemisinin resistance Kelch-13 markers. Conclusions: Reliable efficacy of artesunate for the treatment of severe malaria may no longer be assured in areas where artemisinin resistance has emerged. Empirical addition of parenteral quinine to artesunate for treatment is recommended as a precautionary measure.
ISSN: 14752875
Appears in Collections:Scopus 2018

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