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Antimicrobial Agents and Chemotherapy, May 2000, p. 1302-1308, Vol. 44, No. 5
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Combinations of Artemisinin and Quinine for Uncomplicated Falciparum Malaria: Efficacy and Pharmacodynamics

Peter J. de Vries,1,* Nguyen Ngoc Bich,2 Huynh Van Thien,3 Le Ngoc Hung,2 Trinh Kim Anh,2 Piet A. Kager,1 and Siem H. Heisterkamp4

Division of Infectious Diseases, Tropical Medicine and AIDS1 and Department of Clinical Epidemiology and Biostatistics,4 Academic Medical Center, Amsterdam, The Netherlands, and Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City,2 and Lam Dong Provincial Hospital II, Bao Loc, Lam Dong Province,3 Vietnam

Received 17 June 1999/Returned for modification 31 October 1999/Accepted 9 February 2000

Combinations of artemisinin and quinine for uncomplicated falciparum malaria were studied. A total of 268 patients were randomized to 7 days of quinine at 10 mg/kg of body weight three times a day (Q) or to artemisinin at 20 mg/kg of body weight followed by 3 (AQ3) or 5 (AQ5) days of quinine. Recrudescence rates were 16, 38, and 15% for the Q, AQ3, and AQ5 groups, respectively (P < 0.001). Recrudescence was associated with shorter parasite clearance time (PCT) and longer treatment after the blood smear had become negative (eradication time). However, classification of patients to outcome---recrudescence or radical cure---was correct in only 77% of patients. The population kinetics of the parasitemia was estimated with nonlinear mixed-effect models. Several models were tested, but the best model was a monoexponential decline of the parasitemia in which the mean parasite elimination half-life was shorter after artemisinin (5.1 h; 95% confidence interval [CI], 4.9 to 5.2 h) than after quinine (8.0 h [95% CI, 7.5 to 8.3 h]). Attempts to simulate the initial increase of the parasitemia did not result in better models with a biologically plausible interpretation. Recrudescence was associated with slower parasite clearance and a higher simulated terminal parasitemia (Pterm). The classification of patients to outcome groups based on Pterm was correct in 78% of patients. The data suggest that parasite strains with reduced sensitivity to quinine are prevalent in Vietnam, with slower parasite clearance and consequent recrudescence. A single dose of artemisinin induces rapid parasite reduction and lowers the value of Pterm, but to prevent recrudescence, this should be followed by quinine for at least 3 days after parasite clearance, or 5 days in total.


* Corresponding author. Mailing address: Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center F4.217, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. Phone: 31 20 5662170. Fax: 31 20 6972286. E-mail: p.j.devries{at}amc.uva.nl.


Antimicrobial Agents and Chemotherapy, May 2000, p. 1302-1308, Vol. 44, No. 5
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.



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  • HUNG, L. Q., DE VRIES, P. J., BINH, T. Q., GIAO, P. T., NAM, N. V., HOLMAN, R., KAGER, P. A. (2004). ARTESUNATE WITH MEFLOQUINE AT VARIOUS INTERVALS FOR NON-SEVERE PLASMODIUM FALCIPARUM MALARIA. Am J Trop Med Hyg 71: 160-166 [Abstract] [Full Text]