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Antimicrobial Agents and Chemotherapy, May 2000, p. 1302-1308, Vol. 44, No. 5
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
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Copyright © 2000, American Society for Microbiology. All rights reserved.
Combinations of Artemisinin and Quinine for
Uncomplicated Falciparum Malaria: Efficacy and
Pharmacodynamics
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.
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