Frequency of early rising parasitemia in falciparum malaria treated with artemisinin derivatives.

To define the frequency of the early rising of parasitemia in falciparum malaria patients treated with artemisinin derivatives, a retrospective chart review of 497 patients admitted to the Hospital for Tropical Diseases, Bangkok in 1996 was carried out. Early rising parasitemia, defined as an increase in the parasite count over the baseline pretreatment level during the first 24 hours of treatment, was found in 59/229 episodes (25.8%) of uncomplicated, and 111/268 episodes (41.3%) of complicated falciparum malaria. All uncomplicated cases were successfully treated without developing any complications. There were 2 deaths and 13 changes of drug regimen in the complicated group. Only one of these unfavorable responses was due to parasite response. Early rising parasitemia was very common in falciparum malaria treated with artemisinin derivatives, despite their ability to clear the parasitemia, and did not indicate failure of the drug used.

A randomized clinical trial of combinations of artesunate and azithromycin for treatment of uncomplicated Plasmodium falciparum malaria in Thailand.

Recently, a combination of artesunate and mefloquine has proved effective, although is contraindicated in early pregnancy and young children. Azithromycin, a widely used antibiotic and has antimalarial effects, replace mefloquine as a new alternative antimalarial regimen. Two hundred and two uncomplicated falciparum malaria patients were randomly assigned to 1 of 3 regimens. Patients in group I (n = 68) received artesunate 200 mg once daily for 3 days, group II (n = 67) received artesunate 200 mg together with mefloquine 10 mg/kg on the first 2 days and artesunate 200 mg together with mefloquine 5 mg/kg on the third day, and group III (n = 67) received artesunate 200 mg together with azithromycin 50 mg once daily for 3 days. The 28 day cure rates were 44, 98 and 56%, respectively. The median time to recrudescence was significantly longer in group III. In conclusion, a combination of artesunate and azithromycin might be useful in treating children in whom bacterial and malarial infections may be concomitant. However, further work is required in order to enhance its clinical efficacy.