In vivo monitoring of dihydroartemisinin-piperaquine sensitivity in Plasmodium falciparum along the China-Myanmar border of Yunnan Province, China from 2007 to 2013.

Hui Liu,Lin-Hua Tang,Mei Li,Xiang-Rui Guo,Xing-Liang Li,Jian-Wei Xu,Ren-Hua Nie,Heng-Lin Yang,Jia-Zhi Wang,Jian Wang,Chun-Fu Li,Heng-Ye Wang,Fang Huang,Ying-Xue Lin

doi:10.1186/s12936-015-0584-8

Abstract

BackgroundArtemisinin-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.MethodsEligible 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.Results243 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 (X2 = 2.81, P = 0.7288).ConclusionIn 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.

Highlights

Artemisinin-based combination therapy (ACT) is the recommended first-line treatment of falciparum malaria in all endemic countries
Eight (3.3%, 95% confidence interval, 1.4–6.4%) patients present parasitaemia on day 3 after medication, three in 2010, one in 2011, three in 2012 and one in 2013 (Figure 2); and parasites were spontaneously cleared by day 4
The results showed that 241 (99.2%; 95% CI, 97.1–99.9%) of the patients were ACPR, one early treatment failure (ETF) in 2012 and one late clinical failure (LCF) in 2007, without late parasitological failure (LPF) (Table 3)

Summary

Introduction

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). Artemisininbased combination therapy is the recommended firstline treatment of falciparum malaria in all endemic countries. The emergence of artemisinin resistance in malaria parasites is threatening malaria control and elimination programmes. Artemisinin resistance in Plasmodium falciparum has been identified and confirmed in Cambodia, Thailand, Myanmar, and Vietnam [2,3,4,5,6,7,8,9,10]. The artemisininbased combination therapy (ACT) is the most potent weapon in treating falciparum malaria [11] and no other anti-malarial is available that offers the same level of efficacy and tolerability. Surveillance of artemisinin sensitivity in P. falciparum is one of important components to prevent the emergence of new foci of resistance, as well as to limit the spread of resistance [2]

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