Artemisinin: Difference between revisions
imported>Howard C. Berkowitz (New page: '''Artemisinin''' is currently the most important drug in the treatment of malaria, especially the most lethal form caused by ''Plasmodium falciparum''. The classic form is a [[phy...) |
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'''Artemisinin''' | '''Artemisinin''' and its derivatives are now the most important drugs in the treatment of [[malaria]], especially the most lethal form caused by ''[[Plasmodium falciparum]]''. The classic form is a [[phytotherapy|plant product]] used in [[traditional Chinese medicine]]. | ||
To reduce the development of [[#resistance|resistant ''Plasmodia'']], the standard of care is to use it in jointly with other antimalarial drugs: '''artemisinin combination therapy (ACT)'''. | To reduce the development of [[#resistance|resistant ''Plasmodia'']], the standard of care is to use it in jointly with other antimalarial drugs: '''artemisinin combination therapy (ACT)'''. | ||
==Class drug and derivatives== | ==Class drug and derivatives== | ||
Artemisin itself has relativel low bioavailability and has been banned in some countries. | |||
Artesunate is a derivative that produces higher blood levels when given intravenously. In 2007, the U.S. [[Centers for Disease Control]] (CDC) received an exception from the [[Food and Drug Administration]] to Artesunate in the United States, specifically for treatment of malarial clinical emergencies; CDC will dispense it to requesting organizations that meet treatment criteria. | Artesunate is a derivative that produces higher blood levels when given intravenously. In 2007, the U.S. [[Centers for Disease Control]] (CDC) received an exception from the [[Food and Drug Administration]] to Artesunate in the United States, specifically for treatment of malarial clinical emergencies; CDC will dispense it to requesting organizations that meet treatment criteria. | ||
<ref name=>{{citation | <ref name=>{{citation | ||
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| author = Jorge Rivas}}</ref> | | author = Jorge Rivas}}</ref> | ||
==Resistance== | ==Resistance== | ||
Several drug combinations, however, such | The main drivers of the developing resistance are under-dosing and counterfeit drugs. | ||
One study found that 88 percent of the drugs purchased at local markets contained no or substandard amounts of artemisinin. Many people cannot afford to buy a full treatment course and may therefore be under-dosed even if the drugs contained correct amounts of artemisinin.<ref>{{citation | |||
| author = Sengaloundeth et al. | |||
| title = A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR - implications for therapeutic failure and drug resistance | |||
| journal = Malar J. | |||
| year = 2009 | volume = 8 | page = 172}}</ref> An editorial in Expert Opinion of Anti-Infective Therapy suggested that the only rational way of stopping the spread of artemisinin resistance was to deliver the drug free of charge <ref>{{citation | |||
| author = Schlagenhauf P and Petersen E | |||
| title = Antimalaria drug resistance: the mono-combi-counterfeit triangle | |||
| journal = Expert Rev Anti Infect Ther | |||
| year = 2009 | volume = 7| pages = 1039-42}}</ref> | |||
Several drug combinations, however, such as artesunate, when used with older antimalarial drugs against which resistance already exists, may produce treatment failures, which already may have happened in the historically drug-resistant border between [[Cambodia]] and [[Thailand]]. <ref>{{citation | |||
| author = Wongsrichanalai C, Meshnick SR | | author = Wongsrichanalai C, Meshnick SR | ||
| title = Declining artesunate-mefloquine efficacy against falciparum malaria on the Cambodia–Thailand border | | title = Declining artesunate-mefloquine efficacy against falciparum malaria on the Cambodia–Thailand border | ||
Revision as of 13:44, 30 December 2009
Artemisinin and its derivatives are now the most important drugs in the treatment of malaria, especially the most lethal form caused by Plasmodium falciparum. The classic form is a plant product used in traditional Chinese medicine.
To reduce the development of resistant Plasmodia, the standard of care is to use it in jointly with other antimalarial drugs: artemisinin combination therapy (ACT).
Class drug and derivatives
Artemisin itself has relativel low bioavailability and has been banned in some countries.
Artesunate is a derivative that produces higher blood levels when given intravenously. In 2007, the U.S. Centers for Disease Control (CDC) received an exception from the Food and Drug Administration to Artesunate in the United States, specifically for treatment of malarial clinical emergencies; CDC will dispense it to requesting organizations that meet treatment criteria. [1]
Resistance
The main drivers of the developing resistance are under-dosing and counterfeit drugs. One study found that 88 percent of the drugs purchased at local markets contained no or substandard amounts of artemisinin. Many people cannot afford to buy a full treatment course and may therefore be under-dosed even if the drugs contained correct amounts of artemisinin.[2] An editorial in Expert Opinion of Anti-Infective Therapy suggested that the only rational way of stopping the spread of artemisinin resistance was to deliver the drug free of charge [3]
Several drug combinations, however, such as artesunate, when used with older antimalarial drugs against which resistance already exists, may produce treatment failures, which already may have happened in the historically drug-resistant border between Cambodia and Thailand. [4]
The problem is aggravated by the extensive worldwide practice of self-medication for malaria, coupled with widespread distribution of counterfeit drugs.[5]
References
- ↑ Jorge Rivas (2 August 2007), "CDC to Distribute Novel Drug for the Treatment of Malaria Emergencies", Associated Content
- ↑ Sengaloundeth et al. (2009), "A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR - implications for therapeutic failure and drug resistance", Malar J. 8: 172
- ↑ Schlagenhauf P and Petersen E (2009), "Antimalaria drug resistance: the mono-combi-counterfeit triangle", Expert Rev Anti Infect Ther 7: 1039-42
- ↑ Wongsrichanalai C, Meshnick SR (2008 May), "Declining artesunate-mefloquine efficacy against falciparum malaria on the Cambodia–Thailand border", Emerg Infect Dis [serial on the Internet]
- ↑ Malaria, Artemisin Resistance, Southeast Asia, ProMED, International Society for Infectious Diseases mailing list, 29 Dec 2009