In vitro interaction of dihydroartemisin and lumefantrine in clinical field isolates from Bangladesh

The combination of artemether and lumefantrine was introduced in 2005 as the official first line therapy for uncomplicated falciparum malaria in Bangladesh. Fresh P. falciparum samples from patients with acute uncomplicated falciparum malaria who presented to the field site at the Bandarban Sadar Ho...

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Bibliographic Details
Published in:Wiener Klinische Wochenschrift 2007-11, Vol.119 (19-20 Suppl 3), p.67-70
Main Authors: Thriemer, Kamala, Khan, Wasif Ali, Starzengruber, Peter, Haque, Rashidul, Vossen, Matthias G, Marma, Aung Swi Prue, Akther, Selim, Fukuda, Mark, Noedl, Harald
Format: Article
Language:English
Subjects:
Animals
Antimalarials - administration & dosage
Artemisinins - administration & dosage
Bangladesh
Dose-Response Relationship, Drug
Drug Synergism
Drug Therapy, Combination
Ethanolamines - administration & dosage
Fluorenes - administration & dosage
Humans
Lethal Dose 50
Lumefantrine
Malaria, Falciparum - blood
Malaria, Falciparum - diagnosis
Malaria, Falciparum - drug therapy
Malaria, Falciparum - parasitology
Plasmodium falciparum - drug effects
Plasmodium falciparum - physiology
Survival Rate
Treatment Outcome
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Summary:The combination of artemether and lumefantrine was introduced in 2005 as the official first line therapy for uncomplicated falciparum malaria in Bangladesh. Fresh P. falciparum samples from patients with acute uncomplicated falciparum malaria who presented to the field site at the Bandarban Sadar Hospital in Bangladesh were tested in checkerboard in vitro drug sensitivity assays to assess the interaction between dihydroartemisinin (DHA) and lumefantrine (LUM). Clearly synergistic interactions with an overall mean FIC(50) of 0.52 and individual mean FICs between 0.26 and 0.85 were found. Lowest FICs were 0.41, 0.18, 0.22, 0.15 and 0.11 at different combination ratios. The optimal combination ratio of the drug combination indicated by the lowest mean FIC average was found to be 1:150 DHA:LUM. Although activity correlations between DHA and lumefantrine were significant, indicating possible cross sensitivity patterns, our data confirm that artemether-lumefantrine is a highly synergistic drug combination.
ISSN:0043-5325
1613-7671
DOI:10.1007/s00508-007-0862-8