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A Journal on Internal Medicine

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Panminerva Medica 2000 September;42(3):197-9

language: English

Azithromycin in the treatment of Plasmodium falciparum gametocytes. Preliminary observation

Bregani E. R., Tien T. V., Monzani V., Figini G., Manenti F. *

From the Divisione di Medicina d’Urgenza Ospedale Maggiore ­IRCCS, Milano, Italy
*Mugana Hospital, Bukoba Diocese, Tanzania.


Background. Treatment of malar­ia rep­re­sents a prob­lem as anti­ma­lar­ial ­drugs are rel­a­tive­ly few, and ­because of the increas­ing wide­spread resis­tance of Plasmodium fal­cip­ar­um to ­most of ­these ­drugs. A par­tial effi­ca­cy ­of azithromycin against Pl. fal­cip­ar­um hepat­ic ­stage and ­against troph­o­zoy­tes in the eryth­ro­cyt­ic stag­es of the dis­ease has ­been dem­on­strat­ed. No ­data con­cern­ing the activ­ity ­against gam­e­toc­y­tes are avail­able, and prim­a­quine ­stands as the ­only ther­a­py ­against Pl. fal­cip­ar­um gam­e­toc­y­tes. Primaquine caus­es hae­mol­y­sis in ­patients ­with glu­cose-6-phos­phate dehy­drog­e­nase (G6PD) defi­cien­cy, so prim­a­quine ther­a­py is usu­al­ly avoid­ed. A bet­ter tol­er­at­ed ther­a­py ­against gam­e­toc­y­tes ­would be use­ful to ­reduce malar­ia trans­mis­sion. We ­present the ­results of a ­study con­cern­ing the effi­ca­cy of azith­rom­y­cin in the treat­ment of P. fal­cip­ar­um gam­e­toc­y­tes.
Methods. A pros­pec­tive ­study was per­formed: 4 ­patients ­with Pl. fal­cip­ar­um gam­e­toc­y­tes (3 chil­dren, 1 ­adult) ­were treat­ed ­with azith­rom­y­cin for con­com­i­tant bac­te­ri­al infec­tions; in the mean­time two chil­dren ­with gam­e­toc­y­tes ­were tak­en as con­trol. Azithromycin was admin­is­tered as rec­om­mend­ed.
Results. Gametocytes ­were detect­able in chil­dren ­thick ­blood ­smears ­after 8, 5 and 6 ­days respec­tive­ly ­after the begin­ning of azith­rom­y­cin ther­a­py, ­while ­they ­were unde­tect­able in the ­adult ­thick ­blood ­smear 5 ­days ­after the begin­ning of the ther­a­py. The gam­e­toc­y­tes spon­ta­ne­ous­ly dis­ap­peared in the two con­trols 4 to 6 ­days ­after the begin­ning of obser­va­tion.
Conclusions. These ­data sug­gest ­that azith­rom­y­cin ­seems inef­fec­tive ­against Pl. fal­cip­ar­um gam­e­toc­y­tes. Further stud­ies are need­ed in ­order to deter­mine wheth­er azith­rom­y­cin treat­ed gam­e­toc­y­tes are infec­tive to mos­qui­toes or not, and to con­firm ­this ­first obser­va­tion.

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