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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 24, Issue 4, Pages 215-216
Case Report

Artemisinin Combination Therapy Can Result in Clinical Failure If Oral Therapy Is Not Directly Observed

Wilson W Chan,1,2 Divya Virmani,3 and Dylan R Pillai1,2,3

1Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada
2Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
3Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Intravenous artesunate therapy is the first-line therapy for severe malaria, and is highly efficacious when used in combination with an oral partner drug such as doxycycline or atovaquone-proguanil. However, treatment failure occurs routinely with artesunate monotherapy due to the very short half-life of this drug. In North America, experience with artesunate is limited. With the pressure to discharge patients early, administration of the essential oral partner drug is often left to the discretion of the patient. Thus, treatment failure may be commonplace if nonadherence is a factor, as was observed in the case described in the present report.