title: Association of failures of seven-day courses of artesunate in a non-immune population in Bangui, Central African Republic with decreased sensitivity of Plasmodium falciparum.
abstract: We assessed the efficacy and safety of a seven-day course of artesunate for the treatment of uncomplicated Plasmodium falciparum malaria in 55 non-immune patients living in Bangui, Central African Republic. The parasitologic cure rates were 100%, 95%, and 85% on days 14, 28, and 42, respectively. There were no significant differences in parasitemia density, 50% inhibitory concentration of dihydroartemisinin, and frequency of mutant P. falciparum multidrug resistance 1 codon 86 between patients who were cured and those who displayed recrudescence. However, the 90% inhibitory concentration for dihydroartemisinin and the number of genotypes isolated were both higher in the recrudescent patients (five- and two-fold, respectively). We found an association between recrudescence and decreased sensitivity. This suggests that the use of artemisinin compounds alone will select resistant strains. We conclude that artesunate should not be used in monotherapy even in seven-day courses, but only in combination with other anti-malarials to prevent the emergence of resistant P. falciparum.
authors.affiliation: Institut Pasteur de Bangui, Bangui, Central African Republic. dmenard@pasteur.mg
authors.forename: Didier
authors.initials: D
authors.lastname: Menard
authors.forename: Marcelle Diane
authors.initials: MD
authors.lastname: Matsika-Claquin
authors.forename: Djibrine
authors.initials: D
authors.lastname: Djalle
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Yapou
authors.forename: Alexandre
authors.initials: A
authors.lastname: Manirakiza
authors.forename: Virginie
authors.initials: V
authors.lastname: Dolmazon
authors.forename: Jacques
authors.initials: J
authors.lastname: Sarda
authors.forename: Antoine
authors.initials: A
authors.lastname: Talarmin
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002488:Central African Republic; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics; D012717:Sesquiterpenes / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate