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Therapeutic responses to antimalarial and
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antibacterial drugs in vivax malaria.Plasmodium vivax is the most prevalent malaria infection and is an important cause of morbidity in Central and South America and Asia. Antimalarial antibiotics birth control pregnancy activity of azithromycin ( Zithromax ), artemisinin
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and dihydroartemisinin in fresh isolates of Plasmodium falciparum in Thailand.Antibiotics with antimalarial activity may offer an interesting alternative for
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the treatment of multidrug-resistant falciparum malaria. It can be concluded that in malarious areas of Thailand, double infection with P. In the studies revie here, the therapeutic responses to antimalarial and antibacterial drugs in vivax malaria have been assessed in the Bangkok
antibiotic
Hospital for Tropical Diseases. As the reportedly slow onset of action of azithromycin ( Zithromax ) suggests its combination with fast-acting substances, such as artemisinin-derivatives, dihydroartemisinin (DHA) was
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tested parallel as a possible combination partner. The effective
antibiotics
concentrations found for azithromycin ( Zithromax ) in this study (EC(50) 29.3 micromol/l, EC(90) 77.1 micromol/l blood medium mixture (BMM)) are comparable to those of other antimalarials in the antibiotics class and are considerably higher than those found
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for mefloquine or quinine. A weak activity correlation
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(rho(EC90) 0.352; p 0.028), which could point to a potential cross-sensitivity but is probably of little clinical importance, was found with mefloquine above the EC(50) level. Vivax is generally sensitive to the com antimalarial drugs but high level resistance to chloroquine and/or pyrimethamine has been
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documented in some geographic locations. The prevalence of cryptic falciparum malaria was 8-15% and was higher
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in patients treated with less potent antimalarial drugs. Vivax is com affecting at least 25% of the patients and usually manifests as sequential illnesses. Azithromycin ( Zithromax ), a relatively recent semisynthetic derivative of erythromycin, was tested for its in vitro
antibiotics
activity against fresh isolates of Plasmodium falciparum. Clinical responses to sulfadoxine-pyrimethamine were also poor with evidence
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of high grade resistance in 42% of the patients. This combination may serve as an interesting alternative for tetracycline and doxycycline, which cannot be used in pregnant women and children, and exhibit phototoxicity. Vivax in Thailand is sensitive to chloroquine but has acquired high grade resistance to sulfadoxine-pyrimethamine.. Except for chloroquine and mefloquine which have long plasma half lives and may therefore suppress first relapses, the cumulative cure rates for the short acting antimalarial drugs were similar. The evaluated drugs consisted of the eight most
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widely used antimalarial drugs and antibacterial drugs that possess antimalarial activities (tetracycline, doxycycline, clindamycin or azithromycin). Provided that further clinical trials support the combination of these drugs, DHA may offer an interesting combination partner for azithromycin ( Zithromax ) owing to its rapid onset of action and the comparatively low effective concentrations (EC(50) 1.65 nmol/l, EC(90) 7.10 nmol/l BMM). For accurate comparison of relapse/recrudescence rates in vivax malaria, at least 2 month's follow-up is required. The absence of an activity correlation between azithromycin ( Zithromax ) and chloroquine, quinine and artemisinin emphasises the independence of azithromycin ( Zithromax ) drug response from the sensitivity to these drugs. Of the four antibacterial drugs, clindamycin was more effective than azithromycin and can be an alternative to the
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tetracyclines.

Follow-up studies have revealed that the relapse time in Thai patients with vivax malaria is on average only 3 weeks, but can be suppressed by the slowly eliminated antimalarial drugs such as chloroquine and mefloquine. The activities of these drugs in descending order of parasite clearance times were artesunate, artemether, chloroquine, mefloquine, quinine, halofantrine, primaquine, follo by the antibacterial drugs and lastly sulfadoxine-pyrimethamine. Double infection with Plasmodium falciparum was com and usually manifested 3-4 weeks following clearance of vivax malaria. Nevertheless, the relatively high cost of this combination, as well as the controversial reports of the clinical efficacy, may limit the usefulness of azithromycin ( Zithromax ) in malaria therapy and require an adjustment of previously used treatment regimens.



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