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Auditory assessment of patients with acute uncomplicated Plasmodium falciparum malaria treated with three-day mefloquine-artesunate on the north-western border of Thailand.

Carrara VI, Phyo AP, Nwee P, Soe M, Htoo H, Arunkamomkiri J, Singhasivanon P, Nosten F - Malar. J. (2008)

Bottom Line: They are highly effective and are considered safe, but in animal studies artemisinin derivatives produce neurotoxicity targeting mainly the auditory and vestibular pathways.Hearing loss (threshold > 25 dB) on admission was common (57%) and associated with age only.Neither audiometric or the ABR tests showed clinical evidence of auditory toxicity seven days after receiving oral artesunate and mefloquine.

View Article: PubMed Central - HTML - PubMed

Affiliation: Shoklo Malaria Research Unit, Mae Sot, Thailand. francois@tropmedres.ac

ABSTRACT

Background: The use of artemisinin derivatives has increased exponentially with the deployment of artemisinin combination therapy (ACT) in all malarious areas. They are highly effective and are considered safe, but in animal studies artemisinin derivatives produce neurotoxicity targeting mainly the auditory and vestibular pathways. The debate remains as to whether artemisinin derivatives induce similar toxicity in humans.

Methods: This prospective study assessed the effects on auditory function of a standard 3-day oral dose of artesunate (4 mg/kg/day) combined with mefloquine (25 mg/kg) in patients with acute uncomplicated falciparum malaria treated at the Shoklo Malaria Research Unit, on the Thai-Burmese border. A complete auditory evaluation with tympanometry, audiometry and auditory brainstem responses (ABR) was performed before the first dose and seven days after initiation of the antimalarial treatment.

Results: Complete auditory tests at day 0 (D0) and day 7 (D7) were obtained for 93 patients. Hearing loss (threshold > 25 dB) on admission was common (57%) and associated with age only. No patient had a threshold change exceeding 10 dB between D0 and D7 at any tested frequency. No patient showed a shift in Wave III peak latency of more than 0.30 msec between baseline and D7.

Conclusion: Neither audiometric or the ABR tests showed clinical evidence of auditory toxicity seven days after receiving oral artesunate and mefloquine.

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Related in: MedlinePlus

Pure-air tone conduction thresholds at Day 0 and Day 7, both ears separately. Air-conduction threshold is given as median values with [range], dBL.
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Figure 2: Pure-air tone conduction thresholds at Day 0 and Day 7, both ears separately. Air-conduction threshold is given as median values with [range], dBL.

Mentions: Air-conduction threshold median values and their range by frequencies for the remaining patients are presented in Figure 2. Hearing loss (threshold > 25 dB) in at least one tested frequency in one or both ears was present among 57.0% (53/93) patients, ranging from 1 to 8 frequencies (median: 2 frequencies); hearing loss was bilateral in 33/53 patients (62%); when unilateral, right or left ears were equally affected. The hearing impairment involved high frequencies (6 and 8 kHz) in the majority of cases (44/53, 83%). Threshold values were between 30 and 40 dB for 45 of those patients (85%), equivalent to a mild hearing loss according to the American National Standards Institute (ANSI S3.6, 1996), between 45 and 70 dB for 7 (13%) or moderate hearing loss, and at 85 dB for 1 patient (severe hearing loss). Hearing loss was associated in univariate analysis to age (P < 0.001), but not to sex, body weight, temperature, parasitaemia, tympanometry results, or time to last artesunate treatment.


Auditory assessment of patients with acute uncomplicated Plasmodium falciparum malaria treated with three-day mefloquine-artesunate on the north-western border of Thailand.

Carrara VI, Phyo AP, Nwee P, Soe M, Htoo H, Arunkamomkiri J, Singhasivanon P, Nosten F - Malar. J. (2008)

Pure-air tone conduction thresholds at Day 0 and Day 7, both ears separately. Air-conduction threshold is given as median values with [range], dBL.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2590614&req=5

Figure 2: Pure-air tone conduction thresholds at Day 0 and Day 7, both ears separately. Air-conduction threshold is given as median values with [range], dBL.
Mentions: Air-conduction threshold median values and their range by frequencies for the remaining patients are presented in Figure 2. Hearing loss (threshold > 25 dB) in at least one tested frequency in one or both ears was present among 57.0% (53/93) patients, ranging from 1 to 8 frequencies (median: 2 frequencies); hearing loss was bilateral in 33/53 patients (62%); when unilateral, right or left ears were equally affected. The hearing impairment involved high frequencies (6 and 8 kHz) in the majority of cases (44/53, 83%). Threshold values were between 30 and 40 dB for 45 of those patients (85%), equivalent to a mild hearing loss according to the American National Standards Institute (ANSI S3.6, 1996), between 45 and 70 dB for 7 (13%) or moderate hearing loss, and at 85 dB for 1 patient (severe hearing loss). Hearing loss was associated in univariate analysis to age (P < 0.001), but not to sex, body weight, temperature, parasitaemia, tympanometry results, or time to last artesunate treatment.

Bottom Line: They are highly effective and are considered safe, but in animal studies artemisinin derivatives produce neurotoxicity targeting mainly the auditory and vestibular pathways.Hearing loss (threshold > 25 dB) on admission was common (57%) and associated with age only.Neither audiometric or the ABR tests showed clinical evidence of auditory toxicity seven days after receiving oral artesunate and mefloquine.

View Article: PubMed Central - HTML - PubMed

Affiliation: Shoklo Malaria Research Unit, Mae Sot, Thailand. francois@tropmedres.ac

ABSTRACT

Background: The use of artemisinin derivatives has increased exponentially with the deployment of artemisinin combination therapy (ACT) in all malarious areas. They are highly effective and are considered safe, but in animal studies artemisinin derivatives produce neurotoxicity targeting mainly the auditory and vestibular pathways. The debate remains as to whether artemisinin derivatives induce similar toxicity in humans.

Methods: This prospective study assessed the effects on auditory function of a standard 3-day oral dose of artesunate (4 mg/kg/day) combined with mefloquine (25 mg/kg) in patients with acute uncomplicated falciparum malaria treated at the Shoklo Malaria Research Unit, on the Thai-Burmese border. A complete auditory evaluation with tympanometry, audiometry and auditory brainstem responses (ABR) was performed before the first dose and seven days after initiation of the antimalarial treatment.

Results: Complete auditory tests at day 0 (D0) and day 7 (D7) were obtained for 93 patients. Hearing loss (threshold > 25 dB) on admission was common (57%) and associated with age only. No patient had a threshold change exceeding 10 dB between D0 and D7 at any tested frequency. No patient showed a shift in Wave III peak latency of more than 0.30 msec between baseline and D7.

Conclusion: Neither audiometric or the ABR tests showed clinical evidence of auditory toxicity seven days after receiving oral artesunate and mefloquine.

Show MeSH
Related in: MedlinePlus