Artesunate Dose Escalation for Malaria Treatment
Author Information
Author(s): Delia Bethell, Youry Se, Lon Chanthap, Stuart Tyner, David Saunders, Sabaithip Sriwichai, Sea Darapiseth, Paktiya Teja-Isavadharm, Phisit Khemawoot, Kurt Schaecher, Wiriya Ruttvisutinunt, Jessica Lin, Worachet Kuntawungin, Panita Gosi, Ans Timmermans, Bryan Smith, Socheat Duong, Mark M. Fukuda
Primary Institution: Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
Hypothesis
Higher doses of artesunate than currently recommended might be effective in eliminating artemisinin resistant strains of malaria.
Conclusion
Increasing the daily dose of artesunate does not provide a pharmacodynamic benefit for treating uncomplicated malaria, even in areas with emerging artemisinin resistance.
Supporting Evidence
- Cure rates were high in all treatment groups at 42 days despite almost half the patients remaining parasitemic on Day 3.
- 19% of patients in the high-dose arm developed neutropenia by Day 14.
- Patients with parasitemia >10,000/µL had longer median parasite clearance times.
Takeaway
This study tested if giving more artesunate would help treat malaria better, but it found that higher doses didn't work any better than the usual dose.
Methodology
Adult patients with uncomplicated P. falciparum malaria were randomized into three groups receiving different doses of artesunate for 7 days.
Potential Biases
Potential bias due to the open-label design and the variability in individual pharmacokinetic responses.
Limitations
The study was limited by the small sample size in the high-dose group and the inability to demonstrate a dose-dependent effect.
Participant Demographics
Adult patients aged 18-65 with uncomplicated P. falciparum malaria.
Statistical Information
P-Value
p<0.0001
Statistical Significance
p<0.0001
Digital Object Identifier (DOI)
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