Malaria treatment failures after artemisinin-based therapy in three expatriates: could improved manufacturer information help to decrease the risk of treatment failure ?

Background Artemisinin-containing therapies are highly effective against Plasmodium falciparum malaria. Insufficient numbers of tablets and inadequate package inserts result in sub-optimal dosing and possible treatment failure. This study reports the case of three, non-immune, expatriate workers with P . falciparum acquired in Africa, who failed to respond to artemisinin-based therapy. Sub-therapeutic dosing in accordance with the manufacturers’ recommendations was the probable cause. Method Manufacturers information and drug content included in twenty-five artemisinin-containing specialities were reviewed. Results A substantial number of manufacturers do not follow current WHO recommendations regarding treatment duration and doses. Conclusion This study shows that drug packaging and their inserts should be improved.