Widespread availability of artemisinin monotherapy in the United States.
Article Type: Letter to the editor
Subject: Malaria (Drug therapy)
Malaria (Diagnosis)
Malaria (Research)
Drug therapy, Combination (Health aspects)
Drug therapy, Combination (Research)
Authors: Rakita, Robert M.
Malhotra, Uma
Pub Date: 05/01/2011
Publication: Name: Emerging Infectious Diseases Publisher: U.S. National Center for Infectious Diseases Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 U.S. National Center for Infectious Diseases ISSN: 1080-6040
Issue: Date: May, 2011 Source Volume: 17 Source Issue: 5
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 256931080
Full Text: To the Editor: Artemisin-in-based combination therapies are recommended as first line treatments for Plasmodium falciparum malaria in most areas of the world. The article by Shahinas et al. (1) describes a patient who had P. falciparum malaria after returning from Nigeria. Her isolate had an elevated 50% inhibitory concentration to artemisinin derivatives. She had obtained artesunate in Nigeria and took it weekly for malaria prophylaxis, which might have contributed to the relative resistance found.

In 2009, one artemisinin-based combination therapy (artemether/lumefantrine) became available for use in the United States. However, it is not widely appreciated that artemisinin is actually available in the United States as an herbal supplement for over-thecounter purchase (2). It is marketed for general health maintenance and for treatment of parasitic infections and cancers (Figure), although as with other supplements it is not intended to diagnose, treat, cure, or prevent any disease. As in the patient described by Shahinas et al., widespread use of artemisinin or its derivatives as monotherapies could potentially lead to progressively increasing resistance in P. falciparum malaria (3). Studies in western Cambodia, where artemisinin monotherapy has been available for many years, have revealed in vivo artesunate resistance, with markedly decreased parasite clearance times (3). Progressive spread of artemisinin resistance could have disastrous consequences for the global control of malaria. Thus, minimally regulated use of potent compounds in dietary supplements has the potential for major public health implications.


DOI: 10.3201/eid1705.101532


(1.) Shahinas D, Lau R, Khairnar K, Hancock D, Pillai DR. Artesunate misuse and Plasmodium falciparum malaria in traveler returning from Africa. Emerg Infect Dis. 2010;16:1608-10.

(2.) Malhotra U, Rakita R, Fernandez F, Harris G, Arguin P, Bronzan R, et al. Hepatitis temporally associated with an herbal supplement containing artemisinin--Washington, 2008. MMWR Morb Mortal Wkly Rep. 2009;58:854-6.

(3.) Dondorp AM, Nosten F, Yi P, Das D, Phyo AP, Tarning J, et al. Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2009;361:455-67.

Robert M. Rakita and Uma Malhotra

Author affiliations: University of Washington, Seattle, Washington, USA (R.M. Rakita); and Virginia Mason Medical Center, Seattle (U. Malhotra)

Address for correspondence: Robert M. Rakita, University of Washington, 1959 NE Pacific, Box 356175 Seattle, WA 98195, USA; email: rakita@u.washington.edu
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