Evaluation of Fosmidomycin in Adults with Acute Uncomplicated Plasmodium falciparum Malaria

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Ronnatrai Ruengweerayut
Kesara Na Bangchang



The treatment of malaria is becoming increasingly difficult due to the development of Plasmodiumfalciparum strains resistant to the commonly used antimalarials. There is thus an urgent needfor new, effective, and safe, antimalarial drugs. This study determined the efficacy of fosmidomycinamong patients with uncomplicated P. falciparum infection. Fifteen patients were enrolled to receivefosmidomycin 1,200 mg orally every 8 hours for 7 days on an inpatient basis, followed by scheduledoutpatient visits on days 14, 21, and 28 post-treatment. Five patients withdrew from the study: 1had an equivocal pregnancy test result, 1 developed signs of severe malaria, 1 withdrew consent,and 2 did not receive the full treatment course. Per-protocol analysis showed a 100% cure rate inthe first 7 days, dropping to 22% at 28-day follow-up. No serious adverse effects were observed. Theresult of this study showed that fosmidomycin cleared parasites well in the first 7 days; however,the recrudescence rate was high during the 28 days’ follow-up period. The drug should be useful inthe treatment of acute uncomplicated P. falciparum malaria infection, but combination therapy isneeded to reduce recrudescence, thus improving cure rate.

Keywords: Plasmodium falciparum; fosmidomycin;isopentenyl diphosphate

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