Resistance fears as 'life-saver' malaria drug loses potency
Sarah Boseley, health editor Friday December 2, 2005 The Guardian
A new class of malaria drugs that has been billed as a life-saver for millions of children in Africa and Asia is already losing its potency, scientists warn today in a paper that also suggests the drugs may be being used without proper regulation or controls in some countries.
Experts described the study, showing resistance developing to artemisinin drugs, now universally recommended for malaria treatment by the World Health Organisation, as "a wake-up call".
The content of the paper, which has been published in the Lancet medical journal, will dismay those who have been striving to cut the death toll from malaria of more than a million people a year, 70% of those being children under the age of five and babies.
Resistance to malaria drugs has always been a problem but had become so serious that some of the older drugs, such as choloroquine and, in east Africa, the combination of sulfadoxine-pyrimethamin, had become virtually useless.
Artemisinin compounds, made from plants growing in China, have been widely seen as the answer. They are supposed to be used in combination with other drugs, so as to reduce the chances of the malaria parasite, Plasmodium falciparum, developing resistance to them. A combination of artesunate (an artemisinin derivative) and the older drug mefloquine has been used successfully in Thailand for 10 years without resistance developing.
But scientists from the Pasteur Institute Network report in the Lancet that they found resistance to artemisinin in blood samples from patients in Senegal and in French Guiana. In both countries, they said, the drugs were not being used with proper controls.
The scientists, Ronan Jambou, Eric Legrand and colleagues, also tested blood from patients in Cambodia, where the drugs are controlled, and did not find resistance in those samples.
In French Guiana the scientists uncovered resistance in Cacao, a small town where artemisinin derivatives were being illegally imported from south-east Asia. Resistance was also found in the gold mining region along the Maroni river, where people were treating themselves with illegally imported artemisinin drugs.
In Senegal the artemisinin drugs were being given alone, and not in combination with other anti-malarials, as is normally recommended.
The laboratory tests did not prove that the artemisinin drugs were no longer working in these geographical areas, the researchers said, but it was "the probable first step of an alarming cascade and definitely pleads for increased vigilance and a coordinated and rapid deployment of drug combinations".
In a commentary, Patrick E Duffy and Carol Hopkins Sibley, from the Seattle Biomedical Research Institute, warn that "the expectation that all combinations with artemisinins will have a long therapeutic life may be overly optimistic".
posted
I posted a story recently that they are making good progress on malaria vaccine. See that thread if interested.
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
I believe the problem is the laboratory manipulation, extracting the compound to pill form..
as well as perhaps the drugs used in combo.
Herbalists, shamen and the like have been using Artemisinin whole plant compounds in tea, potent extract form, decoction ect..for centuries with very good results, and no resistance developed.
Pharmaceuticals can make no money growing the plant in optimal conditions and selling the whole herb forms of medicine.
Like so many other natural medicines that are extremely effective...they manipulate it, sell the idea that must be better...
when it never is..
and then resistance develops and the parasite even can mutate.
It's the age old story..
man thinking he can do better than nature in medicine, and in some cases he can't.
This is a shame.
Then they say here in Senegal, where they found resistance.. the drug was used alone, not in combo..but do not say in what form the drug was taken.
Interestingly.. "A combination of artesunate (an artemisinin derivative) and the older drug mefloquine has been used successfully in Thailand for 10 years without resistance developing."
What is the nature of the artesunate derivative?
I also have read that artimisinin concentration in blood drops to 50% after three days (why I pulsed my long term artemesia (whole herb) use five days on and three off, I have had no babesia for over a uear, Mepron in my case created resistance and more insideous symptoms)...tho the Malaria course is short.
Then there is the situation WHO recognized some time ago, where other pharmaceutical anti-malarials had created resistant and more deadly strains of Malaria. They feared then that the strains would be a new challange for Artimisinin.
I just don't think we/they should jump to the conclusion that Artemisia 'isn't effective'..
IMO it has much greater potential than anything they can manufacture, and they need to understand the use of such medicines better, IMO.
They should go talk with the few true Shamen that are left.......... but in order to effect treatment that would ultimately mean re-vamping the whole industry to honor effective cures in their natural state.
The number of children dieing is staggering.. seems pharmaceuticals should get out of the way on this one.
Parasites are smarter and more stealth and resourceful than man.
Mo
Posts: 8337 | From the other shore | Registered: Jul 2002
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riversinger
Frequent Contributor (1K+ posts)
Member # 4851
posted
Lou, I think I missed that thread. Is it in Medical?
Mo, I agree that when they process things, it loses some qualities. Very hard to say when that is beneficial and when it isn't. If herbal medicine was sufficient, there would never have developed anything else.
Also, the Artemisinin that most people are taking is not the same as what is being given in other countries, from what I have heard. Is this good or bad? Dunno.
I read about how you used the Artemisinin in pulsed doses. That makes sense to me. Somehow we are missing something in our current treatment of babesia, or we wouldn't be seeing so many relapses.
posted
Hey, just wanted to give everyone a quick heads-up about this Riamet business.
Please be aware that although the FDA does sometimes approve the import of Riamet in special cases, it is not an FDA-approved drug, and there could be legal ramifications for ordering it from abroad, both for patients and doctors.
I've always thought the whole notion of "trolls" was completely ridiculous, but just had a strange experience that was a reminder--you never know who you are dealing with online.
So everybody, please be cautious with this one!
That's it for the Joe Friday imitation.
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posted
"If herbal medicine was sufficient, there would never have developed anything else."
Riversinger, I am not being contentious here with you at all -- this is a 'pet pieve' of mine regarding the Western medical system..
we certainly have benefitted from certain advances..
however there are a great many effective herbal cures.. including great success in Maleria by old school 'medicine man' treatments with whole herb artimisinin.. I knew of a 'practitioner' personally who treats Maleria with great success in cenral America.
but lots more can be effectively cured by these kinds of methods, where herbal medicine is MORE effective than what has been developed since, more than sufficient.
The reason 'we' have moved away from that is in large part becuse of pharmaceutical business interests. They cannot make money on these practices, and in some cases they are threatened by their efficacy. an interesting book and DVD on the Hoxey clinics for cancer comes to mind....................
Some pharmaceutical drugs have done some good..many have done harm............ and many effective herbal treatments have been left behind...and many of those currently used are under persecution by the FDA.
I think many effective cures were run over by business interests.
Anywho...as far as Babesia, pulsing made allot of sence to me once I read about the Babs lifecycle (in vet literature! thanks to Bpeck's tips on that) and about the studies action of Art in Maleria, and Cancer..and the drop in blood concentration after three days on Art. (got research from Holley Pharmaceuticals).. then, following my blood work, my symptoms, tracking my fever.. I saw this to be effective, and it seemed the blood concentration rate (symptom wise) did indeed drop precipitously by day three.
This worked for me...tho I was also on food and other regimins, cleansing -- as well -- and I did use Riamet first, but the babs symptoms returned. Tho, for others it has been effective in erradicating it.
Then following many months of pulsing Aerimisinin by Holley, 100mg3x a day (based on weight), 5 days on and three off, then four days on and three off (worked better I think) I have had nary a Babs symptom since last September.. and my case was resistant after many months of Mepron.
Mo
Posts: 8337 | From the other shore | Registered: Jul 2002
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riversinger
Frequent Contributor (1K+ posts)
Member # 4851
posted
Its OK, Mo, I know you're not being contentious. I know about all the stuff about Big Pharma, and some of that is part of how we got here. Some is that the herbal medicine wasn't always sufficient. Its both.
My dream is that we can figure out the best combination of scientific understanding with natural methods that are less destructive in all ways. It seems completely possible, except we keep stepping on our own feet.
posted
Correct me if I'm wrong, but isn't this the key difference? Malaria is transmitted from human to human (via mosquitos), while Babesia/Lyme is transmitted from animals to humans (via ticks).
So isn't the concern expressed in the original article (top of thread) that improper treatment of malaria in one human will lead to resistant malaria in other people?
This shouldn't be an issue with Babesia/Lyme, unless mice and deer are being treated improperly with antimalarials and antibiotics, creating resistant strains that are passed on to humans.
I think what concerns most of us is that our own infections, which would only very rarely be passed on to another human, might gradually become impervious to meds because of good old natural selection.
Or it could be that the meds are just not very effective to begin with because they may not penetrate the blood-brain barrier or kill every form of these pleomorphic organisms (e.g., Rocephin won't kill the cyst or intracellular form of Bb). That's another kind of "resistance" altogether.
Bec
Posts: 21 | From NY | Registered: Nov 2005
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actually, Babesia (s well as other TBD's) can be passed by a mosquito (as well as mites and fleas) if the vector comes from and infected source (animal to humans).. or human to human..
Also by blood transfusion and in all probability, congenital transmission as well.
here's a recent study I found alarming in CT blood donors:
Demonstrable parasitemia among Connecticut blood donors with antibodies to Babesia microti
David A. Leiby1, Amy P.S. Chung1, Jennifer E. Gill1, Raymond L. Houghton1, David H. Persing1, Stanley Badon1, Ritchard G. Cable1
BACKGROUND: Reports of transfusion-transmitted Babesia microti have risen steadily during the past several years, reflecting a concurrent increase in US cases of human babesiosis. Although several studies have measured B. microti antibodies in blood donors, little is known about associated parasitemia and the inherent risk of transmitting the parasite by transfusion.
STUDY DESIGN AND METHODS: Donations from blood donors located in Babesia-endemic and nonendemic areas of Connecticut were tested for B. microti antibodies from July through September. Subsequently, an additional blood sample was collected from selected seropositive donors and tested by nested polymerase chain reaction (PCR) for B. microti nucleic acids.
RESULTS: A total of 3490 donations, 1745 each from endemic and nonendemic areas, were tested for B. microti antibodies; 30 (0.9%) were confirmed as positive and seroprevalence rates peaked in July. Significantly more seropositive donations were from endemic areas (24, 1.4%) than nonendemic areas (6, 0.3%). Ten (53%) of 19 seropositive donors subsequently tested by PCR were positive.
CONCLUSION: B. microti seroprevalence was highest in those areas of Connecticut where the parasite is endemic. More than half of seropositive donors tested had demonstrable parasitemia, indicating that many are at risk for transmitting B. microti by blood transfusion. Three donors were identified as parasitemic in October, suggesting that donors may be at risk for transmitting the parasite outside of the peak period of community-acquired infection.
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-- people are supposed to be excluded from blood donations if they have ever been diagnosed with Babesia..
big problems then with all the patients who have no idea whether they have it, and the less than adequate testing (and screening) methods.
Oy.............!
Mo
Posts: 8337 | From the other shore | Registered: Jul 2002
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posted
BTW, several artemesinin derivatives are being clinically tested in the U.S. Johns Hopkins doing one, and another by military. Military one is using artesunate and the study has been going on since at least last year, not sure when they will have results/move on to next level of clinical trials.
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