Assessment of Azithromycin in Combination with Other Antimalarial Drugs against Plasmodium falciparum In Vitro

Antimicrobial Agents and Chemotherapy - Tập 46 Số 8 - Trang 2518-2524 - 2002
Colin Ohrt1, George D. Willingmyre1, Patricia Lee1, Charles Knirsch2,3, Wilbur K. Milhous1
1Department of Pharmacology, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland
2College of Physicians and Surgeons, Columbia University, New York, New York
3Pfizer, inc

Tóm tắt

ABSTRACT

Initial field malaria prophylaxis trials with azithromycin revealed insufficient efficacy against falciparum malaria to develop azithromycin as a single agent. The objective of this in vitro study was to determine the best drug combination(s) to evaluate for future malaria treatment and prophylaxis field trials. In vitro, azithromycin was tested in combination with chloroquine against 10 representative Plasmodium falciparum isolates. Azithromycin was also assessed in combination with eight additional antimalarial agents against two or three multidrug-resistant P. falciparum isolates. Parasite susceptibility testing was carried out with a modification of the semiautomated microdilution technique. The incubation period was extended from the usual 48 h to 68 h. Fifty percent inhibitory concentrations (IC 50 s) were calculated for each drug alone and for drugs in fixed combinations of their respective IC 50 s (1:1, 3:1, 1:3, 4:1, 1:4, and 5:1). These data were used to calculate fractional inhibitory concentrations and isobolograms. Chloroquine-azithromycin studies revealed a range of activity from additive to synergistic interactions for the eight chloroquine-resistant isolates tested, while an additive response was seen for the two chloroquine-sensitive isolates. Quinine, tafenoquine, and primaquine were additive to synergistic with azithromycin, while dihydroartemisinin was additive with a trend toward antagonism. The remaining interactions appeared to be additive. These results suggest that a chloroquine-azithromycin combination should be evaluated for malaria prophylaxis and that a quinine-azithromycin combination should be evaluated for malaria treatment in areas of drug resistance.

Từ khóa


Tài liệu tham khảo

10.4269/ajtmh.1995.52.159

10.1086/516281

10.1093/infdis/137.2.122

10.1006/expr.1995.1049

Craig W. 1997. Postantibiotic effects and the dosing of macrolides azalides and streptogramins p. 27-38. In S. H. Zinner L. S. Young J. F. Acar and H. C. Neu (ed.) Expanding indications for the new macrolides azalides and streptogramins. Marcel Dekker Inc. New York N.Y.

10.1128/AAC.16.6.710

Genovese, R. F., D. B. Newman, K. A. Gordon, and T. G. Brewer. 1999. Acute high dose arteether toxicity in rats. Neurotoxicology20:851-859.

10.1067/mob.2001.118158

10.1038/415670a

Krudsood, S., U. Silachamroon, P. Wilairatana, P. Singhasivanon, W. Phumratanaprapin, K. Chalermrut, N. Phophak, and C. Popa. 2000. A randomized clinical trial of combinations of artesunate and azithromycin for treatment of uncomplicated Plasmodium falciparum malaria in Thailand. Southeast Asian J. Trop. Med. Public Health31:801-807.

10.4269/ajtmh.1996.54.62

Na-Bangchang, K., T. Kanda, P. Tipawangso, A. Thanavibul, K. Suprakob, M. Ibrahim, Y. Wattanagoon, and J. Karbwang. 1996. Activity of artemether-azithromycin versus artemether-doxycycline in the treatment of multiple drug resistant falciparum malaria. Southeast Asian J. Trop. Med. Public Health27:522-525.

Nosten, F., M. Vincenti, J. Simpson, P. Yei, K. L. Thwai, A. de Vries, T. Chongsuphajaisiddhi, and N. J. White. 1999. The effects of mefloquine treatment in pregnancy. Clin. Infect. Dis.28:808-815.

10.1093/clinids/23.3.532

10.1016/S1471-4922(01)02085-2

10.1086/515071

10.4269/ajtmh.2001.64.223

10.1126/science.781840

van Riemsdijk, M. M., M. M. van der Klauw, J. A. van Heest, F. R. Reedeker, R. J. Ligthelm, R. M. Herings, and B. H. Stricker. 1997. Neuro-psychiatric effects of antimalarials. Eur. J. Clin. Pharmacol.52:1-6.

Watt, G., L. Loesuttivibool, G. D. Shanks, E. F. Boudreau, A. E. Brown, K. Pavanand, H. K. Webster, and S. Wechgritaya. 1992. Quinine with tetracycline for the treatment of drug-resistant falciparum malaria in Thailand. Am. J. Trop. Med. Hyg.47:108-111.

10.1016/S0140-6736(98)06439-3

10.1016/0169-4758(96)10055-7

White, N. J., and P. Olliaro. 1998. Artemisinin and derivatives in the treatment of uncomplicated malaria. Med. Trop.58:54-56.

10.1016/0020-7519(94)00119-9

Thông tin
Thông tin xuất bản

Antimicrobial Agents and Chemotherapy

Tập 46 Số 8

2518-2524

Thông tin tác giả