A randomized clinical trial of combinations of artesunate and azithromycin for treatment of uncomplicated Plasmodium falciparum malaria in Thailand.

Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
The Southeast Asian journal of tropical medicine and public health (Impact Factor: 0.55). 01/2001; 31(4):801-7.
Source: PubMed

ABSTRACT Recently, a combination of artesunate and mefloquine has proved effective, although is contraindicated in early pregnancy and young children. Azithromycin, a widely used antibiotic and has antimalarial effects, replace mefloquine as a new alternative antimalarial regimen. Two hundred and two uncomplicated falciparum malaria patients were randomly assigned to 1 of 3 regimens. Patients in group I (n = 68) received artesunate 200 mg once daily for 3 days, group II (n = 67) received artesunate 200 mg together with mefloquine 10 mg/kg on the first 2 days and artesunate 200 mg together with mefloquine 5 mg/kg on the third day, and group III (n = 67) received artesunate 200 mg together with azithromycin 50 mg once daily for 3 days. The 28 day cure rates were 44, 98 and 56%, respectively. The median time to recrudescence was significantly longer in group III. In conclusion, a combination of artesunate and azithromycin might be useful in treating children in whom bacterial and malarial infections may be concomitant. However, further work is required in order to enhance its clinical efficacy.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The macrolide antibiotics, erythromycin and azithromycin, have been studied for their potential antimalarial activity, but only modest activity has been demonstrated. In this study, we investigated the enhancement of the efficacy of these antibiotics in combination with a patented lipid-based drug delivery system, Pheroid technology. A chloroquine resistant strain of Plasmodium falciparum (RSA11) was incubated with the formulations for a prolonged incubation time (144 h). Drug efficacy assays were conducted by analyzing the histidine-rich protein II levels of the parasites. The effects of azithromycin and erythromycin were compared with other antibiotics and standard antimalarial drugs. The poor water soluble nature of the drugs led to the formation of micro scale Pheroid vesicles with average particle sizes of 72.76±10.73 μm for azithromycin and 100.62±29.27 μm for erythromycin. The IC(50) values of erythromycin and azithromycin alone and entrapped in Pheroid vesicles decreased statistically significant (P0.05). Prolonged exposure was also statistically meaningful (P0.05), although it seems that exposure need not exceed 96 h. Pheroid vesicles also proved successful in decreasing the IC(50) values of doxycycline, tetracycline and triclosan. Pheroid vesicles containing antibiotics could prove successful as a malaria treatment option.The Journal of Antibiotics advance online publication, 24 October 2012; doi:10.1038/ja.2012.89.
    The Journal of Antibiotics 10/2012; DOI:10.1038/ja.2012.89 · 2.04 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Der überwiegende Teil der Wirkstoffe in der klinischen Entwicklung entstammt zweier, seit längerem verwendeter Substanzklassen, den 4-Aminochinolinen und den Endoperoxiden. Nur T3 und Fosmidomycin weisen neue Wirkmechanismen auf. Die Entwicklung geeigneter Wirkstoffe gegen Malaria ist kein leichtes Unterfangen – der Zustrom weiterer Testkandidaten wird spärlich bleiben.
    Pharmazie in unserer Zeit 11/2009; 38(6):522-6. DOI:10.1002/pauz.200900339
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reducing the burden of falciparum malaria in pregnancy is an urgent international public health priority but one that involves considerable challenges. The rapidly declining effectiveness of agents known to be safe in pregnancy, and the limited efficacy, safety and pharmacokinetic data available for many other antimalarial drugs, mean that current options for the treatment of both severe and uncomplicated falciparum malaria in pregnancy are limited. This report summarizes the literature on this subject and recommends drug combinations for evaluation in Phase II/III treatment trials in pregnancy.
    Expert Review of Clinical Pharmacology 01/2008; 1(1):61-72. DOI:10.1586/17512433.1.1.61


Available from