Advertisement

Parasitology Research

, Volume 106, Issue 3, pp 549–552 | Cite as

Artemisinin derivatives for treatment of uncomplicated Plasmodium falciparum malaria in Sudan: too early for too much hope

  • Hayder A. GihaEmail author
Review

Abstract

The artemisinin-based combination therapy (ACT) is adopted by several countries as first line for malaria treatment in the last decade. Concomitantly, the World Health Organization and other research reports showed a dramatic decline in malaria burden in terms of morbidity, mortality and treatment failure (TF). The optimistic features of ACT are regularly reported with great hopes, while the pessimistic facets either not existing or underreported. However, the dependence on ACT as a single chemotherapeutic agent for malaria control bears considerable risks. Occurrence and spread of artemisinin derivatives (AD) TF will be a major threat, whether it is due to parasite drug resistance or use of poor drug quality. In addition, the safety of AD is not yet fully known. In this short review, two clinical trials performed to evaluate the efficacy and safety of AD, dihydroartemisinin (DHA) plus chloroquine and artesunate (AS) plus fansidar, in Sudan are critically discussed. The conclusions from both studies were that, the TF rate of DHA indicates arrival of counterfeit AD to Africa, and both rate of TF and undesirable effects of AS/SP were recognized. Both findings indicate that it is too early for too much hope on AD.

Keywords

Malaria Artemisinin Guillain Barre Syndrome Artesunate Malaria Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The two investigations representing the core of this review had received partial financial support from the National Malaria Control Programme (NMCP), Sudan. The NMCP is acknowledged for provision of drugs used in these trials. We received technical and financial support from the joint World Health Organization (WHO) Eastern Mediterranean Region (EMRO), Division of Communicable Disease (DCD) and WHO Special Programme for Research and Training in Tropical Disease (TDR): The EMRO DCD/TDR Small Grants Scheme for Operational Research in Tropical and Other communicable Disease, project number SGS02/110.

References

  1. A-Elbasit IE, Elbashir MI, Khalil IF, Alifrangis M, Giha HA (2006) The efficacy of sulfadoxine-pyrimethamine alone and in combination with chloroquine for malaria treatment in rural Eastern Sudan: the interrelation between resistance, age and gametocytogenesis. Trop Med Int Health 11:604–612CrossRefPubMedGoogle Scholar
  2. Al-Tawil N, Akood MA (1983) Response of falciparum malaria to a standard regimen of chloroquine in Khartoum Province, Sudan. East Afr Med J 60:663–668PubMedGoogle Scholar
  3. Anonymous (2000/2001) News item. Sihanouk Hospital Newsletter 44: 4. Phnom Penh: Sihanouk Hospital Centre of HOPEGoogle Scholar
  4. Ashley EA, McGready R, Hutagalung R, Phaiphun L, Slight T, Proux S, Thwai KL, Barends M, Looareesuwan S, White NJ, Nosten F (2005) A randomized, controlled study of a simple, once-daily regimen of dihydroartemisinin-piperaquine for the treatment of uncomplicated, multidrug-resistant falciparum malaria. Clin Infect Dis 41:425–432CrossRefPubMedGoogle Scholar
  5. Awad-ElKariem FM, Miles MA, Warhurst DC (1992) Chloroquine resistant Plasmodium falciparum isolates from the Sudan lack two mutations in the pfmdr-1 gene thought to be associated with chlororquine resistance. Trans R Soc Trop Med Hyg 86:578–579CrossRefGoogle Scholar
  6. Bayoumi RA, Babiker HA, Ibrahim SM, Ghalib HW, Saeed BO, Khider S, Elwasila M, Karim EA (1989) Chloroquine-resistant Plasmodium falciparum in eastern Sudan. Acta Trop 46:157–165CrossRefPubMedGoogle Scholar
  7. Behrens RH, Carroll B, Smith V, Alexander N (2008) Declining incidence of malaria imported into the UK from West Africa. Malar J 10:235CrossRefGoogle Scholar
  8. Bjorkman A, Phillips-Howard PA (1991) Adverse reactions to sulfa drugs: implications for malaria chemotherapy. Bull WHO 69:297–304PubMedGoogle Scholar
  9. Gosling RD, Chandramohan D (2008) Tackling malaria today: beware resurgence of malaria where incidence has fallen. BMJ 10(337):a1592CrossRefGoogle Scholar
  10. Greenwood B, Mutabingwa T (2002) Malaria in 2002. Nature 415:270–272CrossRefGoogle Scholar
  11. Hallett RL, Sutherland CJ, Alexander N, Ord R, Jawara M, Drakeley CJ, Pinder M, Walraven G, Targett GA, Alloueche A (2004) Combination therapy counteracts the enhanced transmission of drug-resistant malaria parasites to mosquitoes. Antimicrob Agents Chemother 48:3940–3943CrossRefPubMedGoogle Scholar
  12. Hamour S, Melaku Y, Keus K, Wambugu J, Atkin S, Montgomery J, Ford N, Hook C, Checchi F (2005) Malaria in the Nuba Mountains of Sudan: baseline genotypic resistance and efficacy of the artesunate plus sulfadoxine-pyrimethamine and artesunate plus amodiaquine combinations. Trans R Soc Trop Med Hyg 99:548–554CrossRefPubMedGoogle Scholar
  13. Ibrahim ME, Awad-el-Kariem FM, el Hassan IM, el Mubarak ER (1991) A case of Plasmodium falciparum malaria sensitive to chloroquine but resistant to pyrimethamine/sulfadoxine in Sennar, Sudan. Trans R Soc Trop Med Hyg 85:446CrossRefPubMedGoogle Scholar
  14. Krogstad DJ (1996) Malaria as a reemerging disease. Epidemiol Rev 18:77–89PubMedGoogle Scholar
  15. Mukhtar EA, Gadalla NB, El-Zaki SE, Mukhtar I, Mansour FA, Babiker A, El-Sayed BB (2007) A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan. Malar J 15(6):92CrossRefGoogle Scholar
  16. Newton PN, McGready R, Fernandez F, Green MD, Sunjio M, Bruneton C, Phanouvong S, Millet P, Whitty CJ, Talisuna AO, Proux S, Christophel EM, Malenga G, Singhasivanon P, Bojang K, Kaur H, Palmer K, Day NP, Greenwood BM, Nosten F, White NJ (2006) Manslaughter by fake artesunate in Asia—will Africa be next? PLoS Med 3(6):e197CrossRefPubMedGoogle Scholar
  17. Noedl H, Se Y, Schaecher K, Smith BL, Socheat D, Fukuda MM, Artemisinin Resistance in Cambodia 1 (ARC1) (2008) Study Consortium Evidence of artemisinin-resistant malaria in western Cambodia. N Engl J Med 11(359):2619–2620CrossRefGoogle Scholar
  18. Ochong EO, van den Broek IV, Keus K, Nzila A (2003) Short report: association between chloroquine and amodiaquine resistance and allelic variation in the Plasmodium falciparum multiple drug resistance 1 gene and the chloroquine resistance transporter gene in isolates from the upper Nile in southern Sudan. Am J Trop Med Hyg 69:184–187PubMedGoogle Scholar
  19. Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, Marsh K, Snow RW (2007) The decline in paediatric malaria admissions on the coast of Kenya. Malar J 15(6):151CrossRefGoogle Scholar
  20. Omer AH (1978) Response of Plasmodium falciparum in Sudan to oral chloroquine. Am J Trop Med Hyg 27:853–857PubMedGoogle Scholar
  21. Osman ME, Mockenhaupt FP, Bienzle U, Elbashir MI, Giha HA (2007) Field-based evidence for linkage of mutations associated with chloroquine (pfcrt/pfmdr1) and sulfadoxine-pyrimethamine (pfdhfr/pfdhps) resistance and for the fitness cost of multiple mutations in P. falciparum. Infect Genet Evol 7:52–59CrossRefPubMedGoogle Scholar
  22. Price RN, Nosten F, Luxemburger C, ter Kuile FO, Paiphun L, Chongsuphajaisiddhi T, White NJ (1996) Effects of artemisinin derivatives on malaria transmissibility. Lancet 347:1654–1658CrossRefPubMedGoogle Scholar
  23. White N (1999) Antimalarial drug resistance and combination chemotherapy. Philos Trans R Soc Lond B Biol Sci 354:739–749CrossRefPubMedGoogle Scholar
  24. World Health Organization (1996) Assessment of therapeutic efficacy of anti-malarial drugs for uncomplicated malaria in areas with intense transmission. WHO, GenevaGoogle Scholar
  25. World Health Organization (1998) The use of artemisinin and its derivatives as anti- malarial drugs. Malaria Unit, Division of Control of Tropical Disease, WHO, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Biochemistry, Faculty of Medicine and Medical SciencesArabian Gulf University (AGU)ManamaBahrain
  2. 2.Malaria Research Centre (MalRC), Department of Biochemistry, Faculty of MedicineUniversity of KhartoumKhartoumSudan

Personalised recommendations