title: Efficacy of atovaquone-proguanil for treatment of acute multidrug-resistant Plasmodium falciparum malaria in Thailand.
abstract: A combination of atovaquone-proguanil (Malarone); GlaxoSmithKline, Research Triangle Park, NC) was previously shown to be highly effective in the treatment of uncomplicated Plasmodium falciparum malaria. However, there are only limited recent efficacy data, particularly from regions of multidrug resistance. In this study, we examined the efficacy of atovaquone-proguanil for the treatment of uncomplicated P. falciparum malaria on the Thailand-Myanmar border. Patients were given directly observed atovaquone-proguanil (1,000 mg/400 mg) once a day for three days and followed-up for four weeks in a non-transmission area. Of 140 eligible patients enrolled in this open-label study, 97.8% (95% confidence interval = 95.4-100%) responded to therapy and remained clear of parasitemia at follow-up. Mean parasite clearance time was 41.9 hours and mean fever clearance time was 37.1 hours. On the basis of genotyping, three cases of treatment failure were identified (1 RIII and 2 RI). These data indicate that atovaquone-proguanil remains highly efficacious for the treatment of multidrug-resistant P. falciparum malaria in Thailand.
authors.affiliation: Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Srivicha
authors.initials: S
authors.lastname: Krudsood
authors.forename: Samir N
authors.initials: SN
authors.lastname: Patel
authors.forename: Nopaddon
authors.initials: N
authors.lastname: Tangpukdee
authors.forename: Wipa
authors.initials: W
authors.lastname: Thanachartwet
authors.forename: Wattana
authors.initials: W
authors.lastname: Leowattana
authors.forename: Karnchana
authors.initials: K
authors.lastname: Pornpininworakij
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Boggild
authors.forename: Sornchai
authors.initials: S
authors.lastname: Looareesuwan
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D053626:Atovaquone / Q000008:administration & dosage* / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000187:drug effects; D002727:Proguanil / Q000008:administration & dosage* / Q000627:therapeutic use*; D013785:Thailand / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D002727:Proguanil; D053626:Atovaquone