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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.


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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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