Strong gametocytocidal effect of methylene blue-based combination therapy against falciparum malaria: a randomised controlled trial

• Published in: PloS one 2009-05, Vol.4 (5), p.e5318-e5318
• Main Authors: Coulibaly, Boubacar, Zoungrana, Augustin, Mockenhaupt, Frank P, Schirmer, R Heiner, Klose, Christina, Mansmann, Ulrich, Meissner, Peter E, Müller, Olaf
• Format: Article
• Language: English
• Subjects: Amodiaquine; Amodiaquine - administration & dosage; Animals; Antimalarials - administration & dosage; Artemisinins - administration & dosage; Artesunate; Burkina Faso; Child; Children; Clinical trials; Combination therapy; Control methods; Disease transmission; Drug dosages; Drug Therapy, Combination; Drugs; Eradication; Erythrocytes; Gametocytes; Germ Cells - drug effects; Humans; Infectious Diseases/Protozoal Infections; Infectious Diseases/Tropical and Travel-Associated Diseases; Laboratories; Malaria; Malaria, Falciparum - drug therapy; Medical schools; Methylene blue; Methylene Blue - administration & dosage; Methylene Blue - therapeutic use; Parasites; Pediatrics and Child Health; Pharmaceuticals; Plasmodium falciparum; Plasmodium falciparum - drug effects; Public health; Randomization; Therapy; Treatment Outcome; Vector-borne diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0005318

With the availability of new preventive and curative interventions, global malaria control has been strengthened significantly in recent years. Drugs effective in reducing malaria gametocytaemia might contribute to local elimination and possible long-term eradication. We here report on the effects of methylene blue (MB)-based malaria combination therapy on gametocytaemia during a randomised-controlled trial in Burkina Faso. An open-label randomised controlled phase II study in 180 children aged 6-10 years with uncomplicated falciparum malaria was conducted in Nouna, north-western Burkina Faso. Children were randomised to MB-artesunate (AS), MB-amodiaquine (AQ), and AS-AQ (local standard of care). Overall follow-up was for 28 days, follow-up for gametocytaemia was for 14 days. The treatment groups were similar in baseline characteristics and there was only one loss to follow-up. Compared to AS-AQ, both MB-containing regimens were associated with significantly reduced gametocyte carrier rates during follow-up days 3, 7, and 14. This effect was seen both in patients with and without P. falciparum gametocytaemia at baseline. MB reveals pronounced gametocytocidal activity which appears to act against both existing and developing P. falciparum gametocytes. MB-based combination therapy thus has the potential to reduce transmission of P. falciparum malaria in endemic regions, which has important implications for future elimination and eradication strategies. (ClinicalTrials.gov) NCT00354380.