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).

CONCLUSION:

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: Hui Liu, Heng-lin Yang, Lin-hua Tang, Xing-liang Li, Fang Huang, Jia-zhi Wang, Chun-fu Li, Heng-ye Wang, Ren-hua Nie, Xiang-rui Guo, Ying-xue Lin, Mei Li, Jian Wang, Jian-wei Xu
• Journal: Malaria journal (Malar J) Vol. 14 Pg. 47 (Feb 05 2015) ISSN: 1475-2875 [Electronic] England
• PMID: 25652213 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Artemisinins
• Quinolines
• artenimol
• piperaquine

Topics

• Adolescent
• Adult
• Antimalarials (pharmacology, therapeutic use)
• Artemisinins (pharmacology, therapeutic use)
• Child
• Child, Preschool
• China
• Drug Resistance
• Female
• Humans
• Kaplan-Meier Estimate
• Malaria, Falciparum (drug therapy, epidemiology, parasitology)
• Male
• Middle Aged
• Myanmar
• Parasitemia (drug therapy, epidemiology, parasitology)
• Plasmodium falciparum (drug effects)
• Public Health Surveillance
• Quinolines (pharmacology, therapeutic use)
• Young Adult