Malaria treatment failures after artemisinin-based therapy in three expatriates: could improved manufacturer information help to decrease the risk of treatment failure?
BACKGROUND
Artemisinin-containing therapies are highly effective against Plasmodium falciparum malaria. Insufficient numbers of tablets and inadequate package inserts result in sub-optimal dosing and possible treatment failure. This study reports the case of three, non-immune, expatriate workers with P. falciparum acquired in Africa, who failed to respond to artemisinin-based therapy. Sub-therapeutic dosing in accordance with the manufacturers' recommendations was the probable cause.


METHODS
Manufacturers information and drug content included in twenty-five artemisinin-containing specialities were reviewed.


RESULTS
A substantial number of manufacturers do not follow current WHO recommendations regarding treatment duration and doses.


CONCLUSIONS
This study shows that drug packaging and their inserts should be improved.
Jackson
Yves
Y
Travel and Migration Medicine Unit, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. yves.jackson@hcuge.ch
Chappuis
François
F
Loutan
Louis
L
Taylor
Walter
W
D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use*; D000077332:Artesunate; D007560:Cote d'Ivoire; D004305:Dose-Response Relationship, Drug; D004348:Drug Labeling / Q000592:standards; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use; D017408:Guidelines as Topic; D016701:Guinea; D006801:Humans; D007783:Lactones / Q000008:administration & dosage / Q000627:therapeutic use*; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy*; D018512:Parasitemia / Q000188:drug therapy; D012008:Recurrence; D012306:Risk; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000627:therapeutic use*; D013397:Sudan; D013557:Switzerland / Q000208:ethnology; D017211:Treatment Failure; D014944:World Health Organization
D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D007783:Lactones; D012717:Sesquiterpenes; D000077332:Artesunate; D000077549:Artemether; D000078102:Lumefantrine; C075875:artemisin