1/6. Apparent drug failure following artesunate treatment of plasmodium falciparum malaria in Freetown, sierra leone: four case reports.Four cases of plasmodium falciparum malaria who presented in sierra leone in November-December 2000 apparently failed to respond to treatment with artesunate. Three (75%) of the cases fulfilled the world health organization's criteria for late treatment failure. Although artesunate ranks only sixth as the first-line drug used by clinicians for the treatment of uncomplicated malaria in sierra leone, it is widely sold over the counter in pharmacies in the country. The indiscriminate and injudicious use of artesunate among the Sierra Leonean population is likely to increase the level and frequency of resistance among the local strains of P. falciparum. It is recommended that artesunate be reserved for patients who fail to respond to treatment with another of the antimalarial drugs available. Even then, the artesunate should preferably be used in combination with other, longer-acting antimalarial drugs, to slow the development of further resistance.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
2/6. Malarone treatment failure and in vitro confirmation of resistance of Plasmodium falciparum isolate from Lagos, nigeria.We report the first in vitro and genetic confirmation of Malarone (GlaxoSmithKline; atovaquone and proguanil hydrochloride) resistance in plasmodium falciparum acquired in africa. On presenting with malaria two weeks after returning from a 4-week visit to Lagos, nigeria without prophylaxis, a male patient was given a standard 3-day treatment course of Malarone. Twenty-eight days later the parasitaemia recrudesced. parasites were cultured from the blood and the isolate (NGATV01) was shown to be resistant to atovaquone and the antifolate pyrimethamine. The cytochrome b gene of isolate NGATV01 showed a single mutation, Tyr268Asn which has not been seen previously.- - - - - - - - - - ranking = 4keywords = treatment failure (Clic here for more details about this article) |
3/6. Malarone treatment failure not associated with previously described mutations in the cytochrome b gene.Malarone (atovaquone-proguanil) is an effective drug for the treatment and prophylaxis of multidrug-resistant falciparum malaria. However, first cases of resistance have been reported, which are associated with mutations at codon 268 of the parasite's cytochrome b gene. We report the first case of Malarone treatment failure from Central africa.Drug concentration was well within curative range. Pre- and post-treatment plasmodium falciparum isolates revealed codon 268 wild-type alleles, and no other mutations of the putative atovaquone-binding domain.These findings illustrate the spread of atovaquone-proguanil-resistance in africa and question the usefulness of codon 268 as the only target for the surveillance of its emergence.- - - - - - - - - - ranking = 5keywords = treatment failure (Clic here for more details about this article) |
4/6. Early treatment failure in severe malaria resulting from abnormally low plasma quinine concentrations.A patient admitted with severe plasmodium falciparum malaria in western thailand had an early treatment failure with quinine, despite full dosing. plasma quinine concentrations were subtherapeutic. Abnormal quinine pharmacokinetics may explain sporadic reports of quinine treatment failures in severe malaria.- - - - - - - - - - ranking = 6keywords = treatment failure (Clic here for more details about this article) |
5/6. malaria treatment failures after artemisinin-based therapy in three expatriates: could improved manufacturer information help to decrease the risk of treatment failure?BACKGROUND: Artemisinin-containing therapies are highly effective against plasmodium falciparum malaria. Insufficient numbers of tablets and inadequate package inserts result in sub-optimal dosing and possible treatment failure. This study reports the case of three, non-immune, expatriate workers with P. falciparum acquired in africa, who failed to respond to artemisinin-based therapy. Sub-therapeutic dosing in accordance with the manufacturers' recommendations was the probable cause. METHOD: Manufacturers information and drug content included in twenty-five artemisinin-containing specialities were reviewed. RESULTS: A substantial number of manufacturers do not follow current WHO recommendations regarding treatment duration and doses. CONCLUSION: This study shows that drug packaging and their inserts should be improved.- - - - - - - - - - ranking = 9keywords = treatment failure (Clic here for more details about this article) |
6/6. A case of dual chloroquine and halofantrine treatment failure in zimbabwe.A case of malaria treatment failure with chloroquine and halofantrine is reported. The likely determinants and policy considerations are addressed.- - - - - - - - - - ranking = 5keywords = treatment failure (Clic here for more details about this article) |