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. 2012 Jul;87(1):23-8.
doi: 10.4269/ajtmh.2012.12-0058.

No evidence of delayed parasite clearance after oral artesunate treatment of uncomplicated falciparum malaria in Mali

Amelia W Maiga  1 , Bakary Fofana, Issaka Sagara, Demba Dembele, Antoine Dara, Oumar Bila Traore, Sekou Toure, Kassim Sanogo, Souleymane Dama, Bakary Sidibe, Aminatou Kone, Mahamadou A Thera, Christopher V Plowe, Ogobara K Doumbo, Abdoulaye A Djimde
Affiliations

No evidence of delayed parasite clearance after oral artesunate treatment of uncomplicated falciparum malaria in Mali

Amelia W Maiga et al. Am J Trop Med Hyg. 2012 Jul.

Abstract

Plasmodium falciparum resistance to artemisinins by delayed parasite clearance is present in Southeast Asia. Scant data on parasite clearance after artemisinins are available from Africa, where transmission is high, burden is greatest, and artemisinin use is being scaled up. Children 1-10 years of age with uncomplicated malaria were treated with 7 days of artesunate and followed for 28 days. Blood smears were done every 8 hours until negative by light microscopy. Results were compared with a similar study conducted in the same village in 2002-2004. The polymerase chain reaction-corrected cure rate was 100%, identical to 2002-2004. By 24 hours after treatment initiation, 37.0% of participants had cleared parasitemia, compared with 31.9% in 2002-2004 (P = 0.5). The median parasite clearance time was 32 hours. Only one participant still had parasites at 48 hours and no participant presented parasitemia at 72 hours. Artesunate was highly efficacious, with no evidence of delayed parasite clearance. We provide baseline surveillance data for the emergence or dissemination of P. falciparum resistance in sub-Saharan Africa.

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Figures

Figure 1.
Figure 1.
Trial profile. PCT = parasite clearance time.
Figure 2.
Figure 2.
(A and B) Correlation of parasite clearance time with age (A, left panel) and initial parasite density (B, right panel). Both correlations were statistically significant, P = 0.0116 and P < 0.0001 for age and initial parasitemia, respectively (Pearson's coefficient). Individual data points are depicted from all participants with the exception of the two excluded because of treatment change (N = 98). ASB = artesunate Bougoula 2010–2011 study.
Figure 3.
Figure 3.
(A and B) Evolution of parasitemia over time. Panel A (left) shows the evolution of log parasitemia, and panel B (right) shows the evolution of fold initial parasitemia. Individual data points are depicted from all participants who received the correct artesunate dosing with the exception of the two excluded because of treatment change (N = 92). ASB = artesunate Bougoula 2010–2011 study.
Figure 4.
Figure 4.
(A and B) Distribution of parasite clearance rate constants (A, left panel) and slope half-lives (B, right panel). Data are depicted from all participants receiving 4 mg/kg on Day 0 with the exception of the two excluded because of treatment change (N = 92). Data generated by the WorldWide Antimalarial Resistance Network (WWARN) Parasite Clearance Estimator (http://www.wwarn.org/research/parasite-clearance-estimator).
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