Atovaquone-proguanil for recrudescent Plasmodium falciparum in Vietnam.

Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center F4-217, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Annals of Tropical Medicine and Parasitology (Impact Factor: 1.2). 10/2003; 97(6):575-80. DOI: 10.1179/000349803225001427
Source: PubMed

ABSTRACT Malarone, a fixed combination of atovaquone with proguanil (AP), has recently been recognized as a promising treatment against multidrug-resistant Plasmodium falciparum. In Vietnam, the first-line treatment for P. falciparum malaria is currently a combination of mefloquine and an artemisinin derivative, and the use of AP has not been explored. The aim of the present study, based in Vietnam, was to assess the efficacy of AP when used to treat P. falciparum recrudescences that had occurred after primary treatment with mefloquine-artesunate. All but two of the 39 patients investigated completed follow-up. The mean parasite- and fever-clearance times [and 95% confidence intervals (CI)] after AP treatment were 36 (30-42) and 21 (18-24) h, respectively. Most (32) of the 37 infections that were followed adequately appeared to be eradicated by the AP, the other five recrudescing once more. The overall cure 'rate' and (CI) was 86% (76%-98%). All of the patients tolerated the AP well. Atovaquone-proguanil appears to be a safe and promising alternative treatment for P. falciparum infections in South-east Asia, although the combination is relatively expensive and may not clear some infections with multidrug-resistant parasites.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The National Malaria Control Program (NMCP) in Vietnam is based on application of insecticide-treated bed nets (ITNs), spraying of insecticides and early microscopic diagnosis of malaria and treatment (EDTM) with artemisinin drugs. This study explores the implementation of the NMCP at provincial level and its impact on malaria incidence (mi) and prevalence in Binh Thuan in southern Vietnam. Data on implementation of EDTM, distribution of ITNs, annual mi and Plasmodium index (pi) were derived from intervention logbooks and surveillance records kept by the provincial Malaria Station since 1988. The relation between interventions and the change of pi over time was analysed with Generalized Estimating Equations. Control activities focused on the highly endemic zones where ITNs were distributed free of charge to ethnic minority groups, including twice yearly re-impregnation, from 1992 onwards. This almost completely replaced insecticide spraying. Complete ITN coverage of these groups was achieved in 1995, constituting 40% of the entire population. In all malaria endemic communes, primary health care posts were consecutively upgraded or installed, mainly between 1992 and 1995, offering EDTM with artemisinin drugs free of charge. Before 1994, mi peaked to over 50/1000, pi to over 16% in the highly endemic zones. In 1998, these had decreased to below 9/1000 and 4% respectively. The effects of the interventions could not be discerned with statistical significance. Malaria incidence and prevalence declined significantly in Vietnam, possibly due to the malaria control efforts, but coinciding with rapid socioeconomic changes.
    Tropical Medicine & International Health 05/2005; 10(4):357-65. DOI:10.1111/j.1365-3156.2005.01387.x · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Intestinal helminths and blood protozoa are common parasites of lizards. In captivity they can be a serious problem, but no information on treatments is available. In this study, several antiparasitic drugs were studied in Gallotia caesaris (Lacertida) from La Gomera, the Canary Islands, Spain. A lack of efficacy of chloroquine, and a decrease in haemogregarine (Apicomplexa) infection by atovaquone-proguanil was demonstrated. Furthermore, a positive effect of fenbendazole against intestinal nematode infection was observed. In the Canary Islands, Gallotia bravoana and Gallotia simonyi (Lacertida) are included in a captive breading recovery plan. The present results are useful in order to keep these animals in good condition and to control their parasites. Moreover, these results are important for reptiles kept as pets, due to the previous lack of knowledge of parasite management.
    Experimental Parasitology 08/2007; 116(4):361-5. DOI:10.1016/j.exppara.2007.02.004 · 1.86 Impact Factor