Case report
Malarone treatment failure not associated with previously described mutations in the cytochrome b gene
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* Corresponding author: Ole Wichmann ole.wichmann@charite.de
1 Institute of Tropical Medicine, Charité, Humboldt University, Berlin, Germany
2 Virchow Klinikum, Charité, Humboldt University, Berlin, Germany
Malaria Journal 2004, 3:14 doi:10.1186/1475-2875-3-14
Published: 8 June 2004Abstract
Malarone® (atovaquone-proguanil) is an effective drug for the treatment and prophylaxis of multidrug-resistant falciparum malaria. However, first cases of resistance have been reported, which are associated with mutations at codon 268 of the parasite's cytochrome b gene. We report the first case of Malarone® treatment failure from Central Africa.
Drug concentration was well within curative range. Pre- and post-treatment Plasmodium falciparum isolates revealed codon 268 wild-type alleles, and no other mutations of the putative atovaquone-binding domain.
These findings illustrate the spread of atovaquone-proguanil-resistance in Africa and question the usefulness of codon 268 as the only target for the surveillance of its emergence.