Abstract
Because of concerns about possible emergence of artemisinin resistance strains of Plasmodium falciparum in mining areas of the interior of Guyana, a 7-day artesunate trial was conducted from March to December 2014. The day-3 parasite clearance rate, the efficacy of artesunate at day 28, and polymorphism of Kelch 13 (PfK13)—the marker of artemisinin resistance—were assessed. The study confirmed the continued sensitivity of P falciparum to artemisinin. A 7-day course of artesunate was 100% efficacious with only 2% (95% confidence interval, .1%–10.9%) of enrolled subjects positive at day 3. All day-0 parasite samples were wild type. Continued resistance monitoring is nevertheless recommended, given the widespread availability and uncontrolled use of artemisinin drugs in mining areas of Guyana.
Highlights
Because of concerns about possible emergence of artemisinin resistance strains of Plasmodium falciparum in mining areas of the interior of Guyana, a 7-day artesunate trial was conducted from March to December 2014
In the case of suspected artemisinin resistance, a confirmatory study using artesunate monotherapy should be conducted, complemented by sequencing of the polymorphism of Kelch 13 (PfK13) gene of the parasite samples in patients enrolled on day 0 as recommended by the Technical Expert Group on Drug Efficacy and Response
Recent studies have raised concerns regarding the possible emergence of artemisinin resistance in the Guiana shield region of South America
Summary
Because of concerns about possible emergence of artemisinin resistance strains of Plasmodium falciparum in mining areas of the interior of Guyana, a 7-day artesunate trial was conducted from March to December 2014. In the GMS, The World Health Organization (WHO) recommends efficacy monitoring for first-line and second-line ACTs every 2 to 3 years in all endemic countries Such studies aim to determine (1) the proportion of malaria cases with persistent parasitemia at day 3 after treatment with an ACT and (2) the rate of treatment failures at days 28 or 42. In the case of suspected artemisinin resistance (high prevalence of patients with day 3 positive blood smears or emergence of PfK13 mutations), a confirmatory study using artesunate monotherapy should be conducted, complemented by sequencing of the PfK13 gene of the parasite samples in patients enrolled on day 0 as recommended by the Technical Expert Group on Drug Efficacy and Response (http:// www.who.int/malaria/mpac/mar2016/en/). The primary objective of this study was to assess the possible emergence of artemisinin resistance in Guyana by determining the day-3 parasite clearance rate in patients with uncomplicated P falciparum malaria treated with a 7-day course of artesunate monotherapy. Samples from the enrolled patients were analyzed to assess the association of PfK13 polymorphisms with clinical response
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