Richard J. MaudeKamolrat SilamutKatherine PlewesPrakaykaew CharunwatthanaMay HoM. Abul FaizRidwanur RahmanMd Amir HossainMahtab U. HassanEmran Bin YunusGofranul HoqueFaridul IslamAniruddha GhoseJosh HansonJoel SchlatterRachel LaceyAlison EastaughJoel TarningSue J. LeeNicholas J. WhiteKesinee ChotivanichNicholas P.J. DayArjen M. DondorpMahidol UniversityNuffield Department of Clinical MedicineUniversity of CalgaryCentre for Specialized Care and ResearchDev Care FoundationShaheed Shwarwardhy Medical CollegeChittagong Medical College HospitalHopital Jean-VerdierWorcester Royal Infirmary2018-11-092018-11-092014-01-01Journal of Infectious Diseases. Vol.209, No.1 (2014), 120-129002218992-s2.0-84891363760https://repository.li.mahidol.ac.th/handle/20.500.14594/34820Background. Cytoadherence and sequestration of erythrocytes containing mature stages of Plasmodium falciparum are central to the pathogenesis of severe malaria. The oral anthelminthic drug levamisole inhibits cytoadherence in vitro and reduces sequestration of late-stage parasites in uncomplicated falciparum malaria treated with quinine.Methods. Fifty-six adult patients with severe malaria and high parasitemia admitted to a referral hospital in Bangladesh were randomized to receive a single dose of levamisole hydrochloride (150 mg) or no adjuvant to antimalarial treatment with intravenous artesunate.Results. Circulating late-stage parasites measured as the median area under the parasite clearance curves were 2150 (interquartile range [IQR], 0-28 025) parasites/L × hour in patients treated with levamisole and 5489 (IQR, 192-25 848) parasites/L × hour in controls (P =. 25). The "sequestration ratios" at 6 and 12 hours for all parasite stages and changes in microvascular blood flow did not differ between treatment groups (all P >. 40). The median time to normalization of plasma lactate (<2 mmol/L) was 24 (IQR, 12-30) hours with levamisole vs 28 (IQR, 12-36) hours without levamisole (P =. 15).Conclusions. There was no benefit of a single-dose of levamisole hydrochloride as adjuvant to intravenous artesunate in the treatment of adults with severe falciparum malaria. Rapid parasite killing by intravenous artesunate might obscure the effects of levamisole. © 2013 The Author .Mahidol UniversityMedicineArticleSCOPUS10.1093/infdis/jit410