title: Efficacy of dihydroartemisinin-piperaquine for treatment of uncomplicated Plasmodium falciparum and Plasmodium vivax in Cambodia, 2008 to 2010.
abstract: We describe here the results of antimalarial therapeutic efficacy studies conducted in Cambodia from 2008 to 2010. A total of 15 studies in four sentinel sites were conducted using dihydroartemisinin-piperaquine (DP) for the treatment of Plasmodium falciparum infection and chloroquine (CQ) and DP for the treatment of P. vivax infection. All studies were performed according to the standard World Health Organization protocol for the assessment of antimalarial treatment efficacy. Among the studies of DP for the treatment of P. falciparum, an increase in treatment failure was observed in the western provinces. In 2010, the PCR-corrected treatment failure rates for DP on day 42 were 25% (95% confidence interval [CI] = 10 to 51%) in Pailin and 10.7% (95% CI = 4 to 23%) in Pursat, while the therapeutic efficacy of DP remained high (100%) in Ratanakiri and Preah Vihear provinces, located in northern and eastern Cambodia. For the studies of P. vivax, the day 28 uncorrected treatment failure rate among patients treated with CQ ranged from 4.4 to 17.4%; DP remained 100% effective in all sites. Further study is required to investigate suspected P. falciparum resistance to piperaquine in western Cambodia; the results of in vitro and molecular studies were not found to support the therapeutic efficacy findings. The emergence of artemisinin resistance in this region has likely put additional pressure on piperaquine. Although DP appears to be an appropriate new first-line treatment for P. vivax in Cambodia, alternative treatments are urgently needed for P. falciparum-infected patients in western Cambodia.
authors.affiliation: National Center for Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia. rithealeang@gmail.com
authors.forename: Rithea
authors.initials: R
authors.lastname: Leang
authors.forename: Amy
authors.initials: A
authors.lastname: Barrette
authors.forename: Denis Mey
authors.initials: DM
authors.lastname: Bouth
authors.forename: Didier
authors.initials: D
authors.lastname: Menard
authors.forename: Rashid
authors.initials: R
authors.lastname: Abdur
authors.forename: Socheat
authors.initials: S
authors.lastname: Duong
authors.forename: Pascal
authors.initials: P
authors.lastname: Ringwald
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D002160:Cambodia; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D016780:Malaria, Vivax / Q000188:drug therapy*; D008297:Male; D015767:Mefloquine; D026901:Membrane Transport Proteins / Q000235:genetics; D008875:Middle Aged; D021261:Parasitic Sensitivity Tests; D010963:Plasmodium falciparum / Q000187:drug effects; D010966:Plasmodium vivax / Q000187:drug effects; D015800:Protozoan Proteins / Q000235:genetics; D011804:Quinolines / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D002738:Chloroquine; D015767:Mefloquine; D026901:Membrane Transport Proteins; D015800:Protozoan Proteins; D011804:Quinolines; C416369:PfCRT protein, Plasmodium falciparum; C039060:artenimol; C034759:piperaquine; D010879:Piperazines