Assessing parasite clearance during uncomplicated Plasmodium falciparuminfection treated with artesunate monotherapy in Suriname

• Published in: Infection and drug resistance Vol. 9; p. 261
• Main Authors: Vreden, Stephen GS, Bansie, Rakesh D, Jitan, Jeetendra K, Adhin, Malti R
• Format: Journal Article
• Language: English
• Published: Macclesfield Taylor & Francis Ltd 01.01.2016
• Subjects: Artemisinin; Artesunate; Erythrocytes; Gold mines & mining; Infections; Malaria; Microscopy; Mutation; Parasitemia; Parasites; Patients; Plasmodium falciparum; Population; Rainforests; Studies; French Guiana; Suriname
• ISSN: 1178-6973
• DOI: 10.2147/IDR.S113861

Background: Artemisinin resistance in Plasmodium falciparum is suspected when the day 3 parasitemia is >10% when treated with artemisinin-based combination therapy or if >10% of patients treated with artemisinin-based combination therapy or artesunate monotherapy harbored parasites with half-lives ≥5 hours. Hence, a single-arm prospective efficacy trial was conducted in Suriname for uncomplicated P. falciparum infection treated with artesunate-based monotherapy for 3 days assessing day 3 parasitemia, treatment outcome after 28 days, and parasite half-life. Methods: The study was conducted in Paramaribo, the capital of Suriname, from July 2013 until July 2014. Patients with uncomplicated Plasmodium falciparum infection were included and received artesunate mono-therapy for three days. Day 3 parasitaemia, treatment outcome after 28 days and parasite half-life were determined. The latter was assessed with the parasite clearance estimator from the WorldWide Antimalarial Resistance Network (WWARN). Results: Thirty-nine patients were included from July 2013 until July 2014. The day 3 parasitemia was 10%. Eight patients (20.5%) could be followed up until day 28 and showed adequate clinical and parasitological response. Parasite half-life could only be determined from ten data series (25.7%). The median parasite half-life was 5.16 hours, and seven of these data series had a half-life ≥5 hours, still comprising 17.9% of the total data series. Conclusion: The low follow-up rate and the limited analyzable data series preclude clear conclusions about the efficacy of artesunate monotherapy in Suriname and the parasite half-life, respectively. The emergence of at least 17.9% of data series with a parasite half-life ≥5 hours supports the possible presence of artemisinin resistance.