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Staines HM, Burrow R, Teo BHY, Chis Ster I, Kremsner PG, Krishna S. Clinical implications of Plasmodium resistance to atovaquone/proguanil: a systematic review and meta-analysis. J Antimicrob Chemother 2019; 73:581-595. [PMID: 29237012 PMCID: PMC5890752 DOI: 10.1093/jac/dkx431] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022] Open
Abstract
Background Atovaquone/proguanil, registered as Malarone®, is a fixed-dose combination recommended for first-line treatment of uncomplicated Plasmodium falciparum malaria in non-endemic countries and its prevention in travellers. Mutations in the cytochrome bc1 complex are causally associated with atovaquone resistance. Methods This systematic review assesses the clinical efficacy of atovaquone/proguanil treatment of uncomplicated malaria and examines the extent to which codon 268 mutation in cytochrome b influences treatment failure and recrudescence based on published information. Results Data suggest that atovaquone/proguanil treatment efficacy is 89%–98% for P. falciparum malaria (from 27 studies including between 18 and 253 patients in each case) and 20%–26% for Plasmodium vivax malaria (from 1 study including 25 patients). The in vitro P. falciparum phenotype of atovaquone resistance is an IC50 value >28 nM. Case report analyses predict that recrudescence in a patient presenting with parasites carrying cytochrome b codon 268 mutation will occur on average at day 29 (95% CI: 22, 35), 19 (95% CI: 7, 30) days longer than if the mutation is absent. Conclusions Evidence suggests atovaquone/proguanil treatment for P. falciparum malaria is effective. Late treatment failure is likely to be associated with a codon 268 mutation in cytochrome b, though recent evidence from animal models suggests these mutations may not spread within the population. However, early treatment failure is likely to arise through alternative mechanisms, requiring further investigation.
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Affiliation(s)
- Henry M Staines
- Centre for Diagnostics and Antimicrobial Resistance, Institute for Infection & Immunity, St George's University of London, London, UK.,Institute for Infection & Immunity, St George's University of London, London, UK
| | - Rebekah Burrow
- Institute for Infection & Immunity, St George's University of London, London, UK
| | - Beatrix Huei-Yi Teo
- Institute for Infection & Immunity, St George's University of London, London, UK
| | - Irina Chis Ster
- Institute for Infection & Immunity, St George's University of London, London, UK
| | - Peter G Kremsner
- Institut für Tropenmedizin Universitätsklinikum Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Sanjeev Krishna
- Centre for Diagnostics and Antimicrobial Resistance, Institute for Infection & Immunity, St George's University of London, London, UK.,Institute for Infection & Immunity, St George's University of London, London, UK.,Institut für Tropenmedizin Universitätsklinikum Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,St George's University Hospitals NHS Foundation Trust, London, UK
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Ingasia LA, Akala HM, Imbuga MO, Opot BH, Eyase FL, Johnson JD, Bulimo WD, Kamau E. Molecular characterization of the cytochrome b gene and in vitro atovaquone susceptibility of Plasmodium falciparum isolates from Kenya. Antimicrob Agents Chemother 2015; 59:1818-21. [PMID: 25583715 PMCID: PMC4325819 DOI: 10.1128/aac.03956-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/04/2015] [Indexed: 11/20/2022] Open
Abstract
The prevalence of a genetic polymorphism(s) at codon 268 in the cytochrome b gene, which is associated with failure of atovaquone-proguanil treatment, was analyzed in 227 Plasmodium falciparum parasites from western Kenya. The prevalence of the wild-type allele was 63%, and that of the Y268S (denoting a Y-to-S change at position 268) mutant allele was 2%. There were no pure Y268C or Y268N mutant alleles, only mixtures of a mutant allele(s) with the wild type. There was a correlation between parasite 50% inhibitory concentration (IC50) and parasite genetic polymorphism; mutant alleles had higher IC50s than the wild type.
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Affiliation(s)
- Luicer A Ingasia
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
| | - Hoseah M Akala
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
| | - Mabel O Imbuga
- Department of Biochemistry, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Benjamin H Opot
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
| | - Fredrick L Eyase
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
| | - Jacob D Johnson
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
| | - Wallace D Bulimo
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
| | - Edwin Kamau
- Department of Emerging Infectious Diseases-Global Emerging Infections Surveillance and Response System (DEID-GEIS) Program, U.S. Army Medical Research Unit-Kenya (USAMRU-K), Kenya Medical Research Institute (KEMRI)-Walter Reed Project, Kisumu, Kenya
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Desoubeaux G, Simon EG, Perrotin D, Chandenier J. The Mobile Team of Parasitology-Mycology, a medical entity for educational purposes to serve sick patients. J Mycol Med 2013; 24:144-51. [PMID: 24316319 DOI: 10.1016/j.mycmed.2013.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/15/2013] [Accepted: 10/28/2013] [Indexed: 11/20/2022]
Abstract
The Mobile Team of Parasitology-Mycology is a movable entity of the Parasitology-Mycology laboratory of Tours University Hospital, France. In contrast to the usual prerogatives of biomedical laboratories, the Mobile Team of Parasitology-Mycology is requested to intervene directly at bedside in various clinical departments, or even outside the hospital facility. Although its actions are of course primarily devoted to specialized diagnostic and therapeutic purposes, the Mobile Team also plays an important educational role in the medical training of undergraduate or graduate students.
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Affiliation(s)
- G Desoubeaux
- Service de parasitologie, mycologie, médecine tropicale, laboratoire de biologie médicale, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, bâtiment B2A, 1(er) étage, 37044 Tours cedex 09, France; CEPR, unité Inserm U1100/EA 6305, faculté de médecine, université François-Rabelais de Tours, 10, boulevard Tonnellé, 37032 Tours cedex 01, France.
| | - E G Simon
- Commission pédagogique ECN, faculté de médecine, université François-Rabelais de Tours, 10, boulevard Tonnellé, 37032 Tours cedex 01, France; UMR Inserm U930/équipe 5, université François-Rabelais de Tours, 10, boulevard Tonnellé, 37032 Tours cedex 01, France
| | - D Perrotin
- Commission pédagogique ECN, faculté de médecine, université François-Rabelais de Tours, 10, boulevard Tonnellé, 37032 Tours cedex 01, France; Direction décanale de la faculté de médecine, université François-Rabelais de Tours, 10, boulevard Tonnellé, 37032 Tours cedex 01, France
| | - J Chandenier
- Service de parasitologie, mycologie, médecine tropicale, laboratoire de biologie médicale, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, bâtiment B2A, 1(er) étage, 37044 Tours cedex 09, France; CEPR, unité Inserm U1100/EA 6305, faculté de médecine, université François-Rabelais de Tours, 10, boulevard Tonnellé, 37032 Tours cedex 01, France
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Wurtz N, Pascual A, Marin-Jauffre A, Bouchiba H, Benoit N, Desbordes M, Martelloni M, Pommier de Santi V, Richa G, Taudon N, Pradines B, Briolant S. Early treatment failure during treatment of Plasmodium falciparum malaria with atovaquone-proguanil in the Republic of Ivory Coast. Malar J 2012; 11:146. [PMID: 22551095 PMCID: PMC3447648 DOI: 10.1186/1475-2875-11-146] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/02/2012] [Indexed: 11/29/2022] Open
Abstract
The increased spread of drug-resistant malaria highlights the need for alternative drugs for treatment and chemoprophylaxis. The combination of atovaquone‐proguanil (Malarone®) has shown high efficacy against Plasmodium falciparum with only mild side-effects. Treatment failures have been attributed to suboptimal dosages or to parasite resistance resulting from a point mutation in the cytochrome b gene. In this paper, a case of early treatment failure was reported in a patient treated with atovaquone-proguanil; this failure was not associated with a mutation in the parasite cytochrome b gene, with impaired drug bioavailability, or with re-infection.
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Affiliation(s)
- Nathalie Wurtz
- Unité de Parasitologie - Unité de Recherche pour les Maladies Infectieuses et Tropicales Emergentes - UMR 6236, Institut de Recherche Biomédicale des Armées, Marseille, France.
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