Untersuchungen zur in vitro Arzneimittelresistenz bei Malaria tropica in Bangladesch

Abstract

Particularly in Southeast Asia drug resistance has become a major constraint in the treatment of falciparum malaria. So far relatively little is known about the current status of drug resistance in Bangladesh. The aim of this study was therefore to determine the in vitro drug susceptibility of Plasmodium falciparum in south-eastern Bangladesh. In the HRP2 in vitro drug sensitivity assay the tested isolates demonstrated a relatively high sensitivity to dihydroartemisinine (IC50 = 1.33 nM; 95% CI: 1.08-1.63; IC90 = 2.65 nM; 95% CI: 2.13-3.29), mefloquine (IC50 = 11.26 nM, 95% CI: 9.75-13.0; IC90 = 19.55 nM, 95% CI: 15.73-24.29) and quinine (IC50 = 73.24 nM, 95% CI: 65.26-82.21; IC90 = 157.75 nM, (95% CI: 134.16-185.5) thus being significantly more sensitive to mefloquine and quinine than isolates from Thailand. Chloroquine (IC50 = 93.06 nM, 95% CI: 80.38-107.76; IC90 = 214.76 nM, 95% CI: 175.64-262.62) sensitivity was highly compromised with inhibitory concentrations reaching levels comparable to Thailand. Therefore this drug should not be used in the treatment of falciparum malaria in this region. Despite compromised in vitro drug sensitivity to sulfadoxine/pyrimethamine, in clinical studies the combination of sulfadoxine (IC50 = 40.46 microM, 95% CI: 31.15-51.97; IC90 = 173.48 microM, 95% CI: 120.78-249.17) and pyrimethamine (IC50 = 1.7 microM, 95% CI: 1.25-2.3; IC90 = 4.83 microM, 95% CI: 3.17-7.37) with quinine proved to be an interesting option for treating uncomplicated falciparum malaria in Bangladesh.

The Therapeutic Efficacy of Sulfadoxine/Pyrimethamine against <i>Plasmodium falciparum</i> in Yemen

“…In our study, using the in vitro drug sensitivity assay, the EC values for the tested isolates demonstrated a relatively high sensitivity to SP (EC 50 = 5.4820 nmol/l, 95% CI: 4.4445-6.7618, EC 90 = 21.8007 nmol/l, 95% CI: 13.65-34.8164; table 3 ). Our results were similar to those reported in Bangladesh [24] . Therefore, this drug proved to been an interesting option for treating uncomplicated falciparum malaria in Yemen.…”

Modelling malaria treatment practices in Bangladesh using spatial statistics

“…A recent study from Uganda [37] discusses the feasibility of providing vendors with the rapid diagnostic test kits for malaria as a way to encourage proper diagnosis. This strategy could be effective for Bangladesh as well, where drug resistance is already a major hindrance to malaria control [38-40]. …”