title: In vivo monitoring of dihydroartemisinin-piperaquine sensitivity in Plasmodium falciparum along the China-Myanmar border of Yunnan Province, China from 2007 to 2013.
abstract: BACKGROUND
  Artemisinin-based combination therapy (ACT) is the recommended first-line treatment of falciparum malaria in all endemic countries. Artemisinin resistance in Plasmodium falciparum has been confirmed in the Greater Mekong subregion (GMS). Dihydroartemisinin-piperaquine (DAPQ) is the most commonly used ACT in China. To understand the DAPQ sensitivity of P. falciparum, DAPQ resistance was monitored in vivo along the China-Myanmar border from 2007 to 2013.
  
  
  METHODS
  Eligible patients with mono-infections of P. falciparum were recruited to this study after obtaining full informed consent. DAPQ tablets for different categories of kg body weight ranges were given once a day for three days. Patients were followed up for 42 days. Polymerase chain reaction (PCR) was conducted to distinguish between re-infection and recrudescence, to confirm the Plasmodium species. The data were entered and analysed by the Kaplan-Meier method. Treatment outcome was assessed according to the WHO recommended standards.
  
  
  RESULTS
  243 patients were completed valid follow-up. The fever clearance time (FCT) and asexual parasite clearance times (APCT) were, respectively, 36.5 ± 10.9 and 43.5 ± 11.8 hours, and there was an increasing trend of both FCT (F = 268.41, P < 0.0001) and APCT (F = 88.6, P < 0.0001) from 2007 to 2013. Eight (3.3%, 95% confidence interval, 1.4-6.4%) patients present parasitaemia on day three after medication; however they were spontaneous cure on day four. 241 (99.2%; 95% CI, 97.1-99.9%) of the patients were adequate clinical and parasitological response (ACPR) and the proportions of ACPR had not changed significantly from 2007 to 2013 (X(2) = 2.81, P = 0.7288).
  
  
  CONCLUSIONS
  In terms of efficacy, DAPQ is still an effective treatment for falciparum malaria. DAPQ sensitivity in P. falciparum had not significantly changed along the China-Myanmar border of Yunnan Province, China. However more attentions should be given to becoming slower fever and parasite clearance.
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. liubible@126.com.
authors: Hui
authors: H
authors: Liu
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. yang_henglin@sohu.com.
authors: Heng-lin
authors: HL
authors: Yang
authors: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, PR China. ipdtlh@sh163.net.
authors: Lin-hua
authors: LH
authors: Tang
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. lxl5451@yipd.org.
authors: Xing-liang
authors: XL
authors: Li
authors: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, PR China. ipdhuangfang@163.com.
authors: Fang
authors: F
authors: Huang
authors: Tengchong County Center for Disease Control and Prevention, Tengchong, 679100, China. tcwangjiazhi@yahoo.com.cn.
authors: Jia-zhi
authors: JZ
authors: Wang
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. lichunfu@yipd.org.
authors: Chun-fu
authors: CF
authors: Li
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. wanghengye@yipd.org.
authors: Heng-ye
authors: HY
authors: Wang
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. nrh912@yipd.org.
authors: Ren-hua
authors: RH
authors: Nie
authors: Yangjiang County Center for Disease Control and Prevention, Yingjiang, 679300, China. xiaoduorong@vip.qq.com.
authors: Xiang-rui
authors: XR
authors: Guo
authors: Yangjiang County Center for Disease Control and Prevention, Yingjiang, 679300, China. yjjkzx@163.com.
authors: Ying-xue
authors: YX
authors: Lin
authors: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, PR China. li_mei76@163.com.
authors: Mei
authors: M
authors: Li
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. wj5369609@yipd.org.
authors: Jian
authors: J
authors: Wang
authors: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China. xjw426@163.com.
authors: Jian-wei
authors: JW
authors: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use; D037621:Artemisinins / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002681:China; D004351:Drug Resistance; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D008875:Middle Aged; D002052:Myanmar; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D010963:Plasmodium falciparum / Q000187:drug effects*; D062486:Public Health Surveillance; D011804:Quinolines / Q000494:pharmacology* / Q000627:therapeutic use; D055815:Young Adult; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
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