Impaired clinical response in a patient with uncomplicated falciparum malaria who received poor-quality and underdosed intramuscular artemether.
We describe an adult with uncomplicated Plasmodium falciparum malaria who did not improve clinically despite 5 days of intramuscular artemether therapy. He was prescribed a lower dose (kg body weight) than that recommended, and a vial from the packet contained only 74% of the artemether dose as stated by the manufacturer. The combination of underdosing, poor-quality drug, and the intrinsic low bioavailability of artemether may have contributed to his poor clinical response. Analysis of the packaging and chemical "fingerprinting" of the artemether suggested that the drug was genuine but was either substandard or had deteriorated after manufacture.
Keoluangkhot
Valy
V
Adult Infectious Disease Ward, Mahosot Hospital, Vientiane, Lao PDR.
Green
Michael D
MD
Nyadong
Leonard
L
Fernández
Facundo M
FM
Mayxay
Mayfong
M
Newton
Paul N
PN
D000328:Adult; D000962:Antimalarials / Q000009:adverse effects* / Q000592:standards*; D000077549:Artemether; D037621:Artemisinins / Q000009:adverse effects* / Q000592:standards*; D004358:Drug Therapy / Q000592:standards*; D006801:Humans; D007812:Laos; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D000077549:Artemether