Partial artemisinin resistance in Ugandan children with complicated malaria
Resistance to severe malaria in Uganda
Background: Intravenous artesunate, a semi-synthetic derivative of artemisinin, is the treatment recommended by the World Health Organization (WHO) for malaria requiring parenteral treatment. Malaria caused 608,000 deaths in 2022, mainly due to Plasmodium falciparum. Partial artemisinin resistance due to Pfkelch13 variations has been documented in East Africa in uncomplicated malaria, but not in complicated malaria.
Methods: A study was conducted in children aged 6 months to 12 years with complicated malaria treated with parenteral artesunate followed by oral artemether/lumefantrine in Jinja, Uganda, from 2021 to 2022.
Results: This study revealed partial artemisinin resistance in Ugandan children with complicated malaria, associated with Pfkelch13 A675V variation and suboptimal efficacy at 28 days.
Artemisinin Partial Resistance and the Treatment of Severe Malaria
Background: One of the greatest threats to malaria control is the emergence of partial artemisinin resistance (ART-R) in Plasmodium falciparum, the most virulent human malaria parasite, in many African countries.1 Artemisinins are fast-acting antimalarial therapeutic agents that are key components of artemisinin-based combination therapy, which combines an artemisinin derivative with a longer-acting partner drug to treat uncomplicated falciparum malaria. Artemisinin-based combination therapies are the standard of care for this indication. In addition, the artemisinin derivative artesunate, administered intravenously or intramuscularly, is the standard of care for treating severe falciparum malaria, offering significantly improved survival over the previous standard, quinine, in African children.Partial artemisinin resistance manifests as delayed parasite clearance after treatment and was first identified in Southeast Asia in 2008.