Declining Effectiveness of Artesunate-Mefloquine for Malaria
Author Information
Author(s): Wongsrichanalai Chansuda, Meshnick Steven R.
Primary Institution: US Naval Medical Research Unit No. 2
Hypothesis
How can existing P. falciparum–resistant strains be controlled and how can the evolution of new ACT-resistant strains be avoided elsewhere?
Conclusion
Emerging resistance to artesunate-mefloquine is a significant concern on the Cambodia–Thailand border, indicating a need for improved drug use and monitoring.
Supporting Evidence
- Clinical studies showed declining efficacy of artesunate-mefloquine over time.
- Resistance to mefloquine has been documented in the Cambodia–Thailand border region.
- High copy numbers of the pfmdr1 gene are associated with treatment failures.
Takeaway
Some medicines for malaria are not working as well anymore, especially in certain areas, so we need to be careful about how we use them.
Methodology
The study involved clinical monitoring of artesunate-mefloquine efficacy in patients over specified follow-up periods.
Potential Biases
Potential biases include variations in drug quality and patient compliance in field situations.
Limitations
The studies were small and may have overestimated therapeutic efficacy due to follow-up duration and genotyping methods.
Participant Demographics
Participants included children and adults, with a focus on those over 10 years old in some studies.
Statistical Information
Confidence Interval
66.4%–91.1%
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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