Antischistosomal efficacy of artesunate combination therapies administered as curative treatments for malaria attacks

Abstract

Artesunate is a highly effective anti-malarial and there is some evidence that it is also active against schistosome infections. Therefore, we investigated whether treatment with artesunate of acute malaria in Senegalese children had an impact on their level of infection with Schistosoma haematobium. Twenty seven children entered into a clinical trial of antimalaria treatment were excreting eggs of S. haematobium in their urine on the day of treatment, 15 of whom received the combination of a single dose of sulfadoxine/pyrimethamine together with three daily doses of artesunate (4 mg/kg), the remaining 12 children receiving three daily doses of amodiaquine and artesunate. The overall cure rate and reduction in the mean number of excreted eggs 28 days post-treatment were 92.6% and 94.5%, respectively. Our findings indicate that artesunate, in addition to being a very effective treatment for uncomplicated malaria, can also reduce sharply the S. haematobium loads harboured by pre-school African children.

Soil transmitted helminth infections and schistosomiasis in school age children in sub-Saharan Africa: Efficacy of chemotherapeutic intervention since World Health Assembly Resolution 2001

“…artesunate, amodiaquine and sulphadoxine-pyremethamine were also reasonably effective (Thiong'o et al, 2002;Inyang-Etoh, 2004;Boulanger et al, 2007;Inyang-Etoh et al, 2009). Oxamniquine is the only main alternative antischistosomal drug, but its use is declining and moreover in contrast to praziquantel, which displays activity against all human schistosome species, the activity of oxamniquine is confined to S. mansoni (Utzinger et al, 2003).…”

“…The antimalarial drugs particularly the derivatives of artemisinin (e.g., artemether and artesunate), have been shown to be schistosomicidal and have exhibited high parasitological cure rates. Consequently discussions are on-going on how this evidence base can be translated into sound public health actions and the possible implications especially in sub-Saharan Africa where the malaria scourge is most severe (Utzinger et al, 2001a;2001b;Inyang-Etoh et al, 2009;Boulanger et al, 2007).…”

“…Other schistosomicidal drugs such as ART and OXA produced cure rates >70% in Nigeria (Inyang-Etoh et al, 2004) and Kenya (Thiong'o et al, 2002) respectively. It was demonstrated in two studies that drug combinations such as PZQ+ART, SP+ART, AMQ+ART produced higher cure rates than when one drug type was used (Inyang-Etoh et al 2008;Boulanger et al, 2007) (Table 1). Cure rates for S. mansoni ranged from 57.8% in Uganda (Kabatereine et al, 2007) to 100% in South Africa ), while cure rates for S. haematobium ranged from 33.0% in Cote d'Ivoire (N'Goran et al, 2001) to 94.5% in Senegal (Boulanger et al, 2007).…”

In vitro effects of amodiaquine on paired Schistosoma mansoni adult worms at concentrations of less than 5 µg/mL

“…Although monotherapy with artesunate (ART) in Schistosoma haematobium-infected children yields a low cure rate of 21% (Keiser et al 2010), a high cure rate of 100% was obtained with the combination therapy of ART and AQ (Boulanger et al 2007). These results suggest that AQ strongly exhibits antischistosomal activity.…”

Control of Schistosomiasis

“…The authors concluded that artemether was active against S haematobium (N'Goran et al, 2003). Boulanger et al (2007) have also associated artesunate combination therapies with high cure rate of S. haematobium infection in Senegal. This author and colleagues investigated the efficacy of artesunate in the treatment of urinary schistosomiasis in Nigeria (Inyang-Etoh et al, 2004) (Table 2).…”