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artemisinin-based combination therapy

Evidence for treating malaria with artemisinin-based combination therapy in the first trimester of pregnancy

August 3, 2020 - 16:40 -- Open Access
Gutman JR, Chico RM
Lancet Infect Dis. 2020 Aug; 20(8):880-881

Treatment of malaria during pregnancy requires balancing the need for radical cure while avoiding teratogenic exposure. In The Lancet Infectious Diseases, Makoto Saito and colleagues report the results of a systematic review and meta-analysis that used individual patient data on antimalarial efficacy and tolerability in pregnancy.

NOT Open Access | Plasmodium falciparum Isolates Carrying pfk13 Polymorphisms Harbor the SVMNT Allele of pfcrt in Northwestern Indonesia

July 27, 2020 - 12:26 -- NOT Open Access
Lubis IND, Wijaya H, Lubis M, Lubis CP, Beshir KB, Sutherland CJ
Antimicrob Agents Chemother. 2020 Jul 22; 64(8):e02539-19

Artemisinin-based combination therapy (ACT) is the first-line antimalarial regimen in Indonesia. Susceptibility of Plasmodium falciparum to artemisinin is falling in the Greater Mekong subregion, but it is not known whether the efficacy of current combinations is also threatened in nearby Sumatera. We evaluated the genetic loci pfcrt, pfmdr1, and pfk13, considered to be under selection by artemisinin combination therapy, among 404 P. falciparum infections identified by PCR detection in a cross-sectional survey of 3,731 residents of three regencies.

Electrocardiographic safety evaluation of extended artemether-lumefantrine treatment in patients with uncomplicated Plasmodium falciparum malaria in Bagamoyo District, Tanzania

July 15, 2020 - 15:11 -- Open Access
Lwidiko E. Mhamilawa, Sven Wikström, Bruno P. Mmbando, Billy Ngasala and Andreas Mårtensson
Malaria Journal 2020 19:250, 14 July 2020

Extended artemisinin-based combination therapy (ACT) for treatment of uncomplicated Plasmodium falciparum malaria with already existing drug regimens, such as artemether-lumefantrine, might be effective in tackling the emerging ACT resistance. However, given the history of cardiotoxicity among anti-malarial drugs structurally similar to lumefantrine, the potential effect of extended artemether-lumefantrine treatment on the electrocardiographic (ECG) QTc interval is of high concern.

Surveillance of genetic markers associated with Plasmodium falciparum resistance to artemisinin-based combination therapy in Pakistan, 2018–2019

June 9, 2020 - 16:16 -- Open Access
Abdul Qader Khan, Leyre Pernaute-Lau, Aamer Ali Khattak, Sanna Luijcx, Berit Aydin-Schmidt, Mubashir Hussain, Taj Ali Khan, Farees Uddin Mufti and Ulrika Morris
Malaria Journal 2020 19:206, 8 June 2020

The spread of artemisinin resistance in the Greater Mekong Subregion of Southeast Asia poses a significant threat for current anti-malarial treatment guidelines globally. The aim of this study was to assess the current prevalence of molecular markers of drug resistance in Plasmodium falciparum in the four provinces with the highest malaria burden in Pakistan, after introducing artemether–lumefantrine as first-line treatment in 2017.

Efficacy and safety of artemisinin-based combination therapy and the implications of Pfkelch13 and Pfcoronin molecular markers in treatment failure in Senegal

June 2, 2020 - 14:08 -- Open Access
Diallo MA, Yade MS, Ndiaye D, et al.
Sci Rep. 2020 Jun 1; 10(1):8907

In 2006, Senegal adopted artemisinin-based combination therapy (ACT) as first-line treatment in the management of uncomplicated malaria. This study aimed to update the status of antimalarial efficacy more than ten years after their first introduction. This was a randomized, three-arm, open-label study to evaluate the efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DP) in Senegal.

Molecular surveillance over 14 years confirms reduction of Plasmodium vivax and falciparum transmission after implementation of Artemisinin-based combination therapy in Papua, Indonesia

May 13, 2020 - 13:51 -- Open Access
Pava Z, Puspitasari AM, Rumaseb A, Handayuni I, Trianty L, Utami RAS, Tirta YK, Burdam F, Kenangalem E, Wirjanata G, Kho S, Trimarsanto H, Anstey NM, Poespoprodjo JR, Noviyanti R, Price RN, Marfurt J, Auburn S
PLoS Negl Trop Dis 14(5): e0008295

Genetic epidemiology can provide important insights into parasite transmission that can inform public health interventions. The current study compared long-term changes in the genetic diversity and structure of co-endemic Plasmodium falciparum and P. vivax populations. The study was conducted in Papua Indonesia, where high-grade chloroquine resistance in P. falciparum and P. vivax led to a universal policy of Artemisinin-based Combination Therapy (ACT) in 2006.

The role of complement immune response on artemisinin-based combination therapy in a population from malaria endemic region of Western Kenya

May 4, 2020 - 15:16 -- Open Access
Christine N. L. Wanjala, Elke Bergmann-Leitner, Hoseah M. Akala, Geoffrey Odhiambo, Bernhards R. Ogutu, Ben Andagalu, Edwin Kamau and Daniel Ochiel
Malaria Journal 2020 19:168, 29 April 2020

Naturally acquired immunity (NAI), which is characterized by protection against overt clinical disease and high parasitaemia, is acquired with age and transmission intensity. The role of NAI on the efficacy of anti-malarial drugs, including artemisinin-based combinations used as the first-line treatment for uncomplicated Plasmodium falciparum, has not been fully demonstrated. This study investigated the role of NAI in response to artemisinin-based combination therapy (ACT), in symptomatic patients living in western Kenya, a high malaria transmission area.

Evaluation of residual submicroscopic Plasmodium falciparum parasites 3 days after initiation of treatment with artemisinin-based combination therapy

April 23, 2020 - 10:26 -- Open Access
Richard Mwaiswelo and Bill Ngasala
Malaria Journal 2020 19:162, 21 April 2020

Plasmodium falciparum resistance against artemisinin has not emerged in Africa; however, there are reports of the presence of polymerase chain reaction-determined residual submicroscopic parasitaemia detected on day 3 after artemisinin-based combination therapy (ACT). These residual submicroscopic parasites are thought to represent tolerant/resistant parasites against artemisinin, the fast-acting component of the combination.

First trimester use of artemisinin-based combination therapy and the risk of low birth weight and small for gestational age

April 13, 2020 - 13:45 -- Open Access
Orvalho Augusto, Andy Stergachis, Esperança Sevene, et al.
Malaria Journal 2020 19:144, 8 April 2020

While there is increasing evidence on the safety of artemisinin-based combination therapy (ACT) for the case management of malaria in early pregnancy, little is known about the association between exposure to ACT during the first trimester and the effect on fetal growth.

Healthcare professionals’ perspective can guide post-marketing surveillance of artemisinin-based combination therapy in Uganda

February 14, 2020 - 16:29 -- Open Access
Helen Byomire Ndagije, Ronald Kiguba, Niko Speybroeck, et al.
Malaria Journal 2020 19:63, 10 February 2020

Efficient testing to identify poor quality artemisinin-based combination therapy (ACT) is important to optimize efforts to control and eliminate malaria. Healthcare professionals interact with both ACT and malaria patients they treat and hence could observe, first-hand, suspect poor quality artemisinin-based combinations linked to poor malaria treatment outcomes and the factors associated with inappropriate use or treatment failure.


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