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Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies

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dc.contributor.authorGomes, M.
dc.contributor.authorRibeiro, I.
dc.contributor.authorWarsame, M.
dc.contributor.authorKarunajeewa, H.
dc.contributor.authorPetzold, M.
dc.date.accessioned2012-03-30T07:31:12Z
dc.date.available2012-03-30T07:31:12Z
dc.date.issued2008
dc.description.abstractBACKGROUND: Rectal administration of artemisinin derivatives has potential for early treatment for severe malaria in remote settings where injectable antimalarial therapy may not be feasible. Preparations available include artesunate, artemisinin, artemether and dihydroartemisinin. However each may have different pharmacokinetic properties and more information is needed to determine optimal dose and comparative efficacy with each another and with conventional parenteral treatments for severe malaria. METHODS: Individual patient data from 1167 patients in 15 clinical trials of rectal artemisinin derivative therapy (artesunate, artemisinin and artemether) were pooled in order to compare the rapidity of clearance of Plasmodium falciparum parasitaemia and the incidence of reported adverse events with each treatment. Data from patients who received comparator treatment (parenteral artemisinin derivative or quinine) were also included. Primary endpoints included percentage reductions in parasitaemia at 12 and 24 hours. A parasite reduction of >90% at 24 hours was defined as parasitological success. RESULTS: Artemisinin and artesunate treatment cleared parasites more rapidly than parenteral quinine during the first 24 hours of treatment. A single higher dose of rectal artesunate treatment was five times more likely to achieve >90% parasite reductions at 24 hours than were multiple lower doses of rectal artesunate, or a single lower dose administration of rectal artemether. CONCLUSION: Artemisinin and artesunate suppositories rapidly eliminate parasites and appear to be safe. There are less data on artemether and dihydroartemisinin suppositories. The more rapid parasite clearance of single high-dose regimens suggests that achieving immediate high drug concentrations may be the optimal strategy.en
dc.identifier.citationBMC Infect Dis
dc.identifier.issn1471-2334 (Electronic) 1471-2334 (Linking)
dc.identifier.urihttps://hdl.handle.net/10986/5085
dc.language.isoEN
dc.relation.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/igo
dc.rights.holderWorld Bank
dc.subjectAdministration, Rectal
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAnimals
dc.subjectAntimalarials
dc.subjectArtemisinins
dc.subjecttherapeutic use
dc.subjectChild
dc.subjectPreschool
dc.subjectHumans
dc.subjectInfant
dc.subjectNewborn
dc.subjectMalaria
dc.subjectMiddle Aged
dc.subjectParasitemia/drug therapy
dc.subjectPlasmodium falciparum
dc.titleRectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studiesen
dc.title.alternativeBMC Infect Disen
dc.typeJournal Articleen
dc.typeArticle de journalfr
dc.typeArtículo de revistaes
dspace.entity.typePublication
okr.doctypeJournal Article
okr.externalcontentExternal Content
okr.identifier.doi10.1186/1471-2334-8-39
okr.identifier.externaldocumentum1789
okr.identifier.internaldocumentum18373841
okr.journal.nbpages39
okr.language.supporteden
okr.peerreviewAcademic Peer Review
okr.relation.associatedurlhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18373841
okr.volume8
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