The use of artemether-lumefantrine for the treatment of uncomplicated Plasmodium vivax malaria

The long-standing dearth of knowledge surrounding Plasmodium vivax, the most widely distributed of the malaria species, merits urgent attention. A growing awareness of the true burden of this parasite and its potential to cause severe disease, and the identification of increasing parasite resistance in many areas of the world to chloroquine, the mainstay of vivax treatment, underscores the need to identify new and effective treatment strategies. Artemisinin-based combination therapies (ACTs) have been widely adopted as first-line treatment for P. falciparum malaria and would offer logistic benefits in areas of co-endemicity. However, while ACTs show high and similar efficacy against the blood stages of P. vivax, neither ACTs nor chloroquine are active against vivax hypnozoites and must be complemented with a full course of primaquine to eradicate dormant vivax hypnozoites and prevent relapses. Artemether-lumefantrine (AL), the most commonly deployed ACT, has shown rapid clearance of P. vivax parasitemia and fever. The relatively short half-life of lumefantrine would appear beneficial in terms of reducing risk of resistance when compared to other ACTs. However, it has a shorter capability to suppress vivax relapses or prevent de novo infections, which generally translates into comparatively lower in vivo short-term measures of efficacy (e.g., day 28 or day 42 uncorrected cure rates). Assuming that the different artemisinin derivatives have equivalent efficacy against vivax, differences between AL and other ACTs may be restricted to the duration of plasma therapeutic levels of the partner drug, a variable of limited clinical relevance, particularly in regions with low vivax transmission rates or in cases where primaquine is added to the regimen to prevent relapses. More rigorous assessment of the use of ACTs in general, and AL in particular, for the treatment of P. vivax infections, either alone or in combination with primaquine, is merited. In the meantime, AL treatment of vivax malaria may be a pragmatic choice for areas with chloroquine-resistant P. vivax, and in co-endemic areas where AL is already used routinely against P. falciparum and parasitological differentiation is not routinely performed or only clinical diagnosis is used.     

The prophylactic use of antibiotics in cell culture

This article describes the historical development of the prophylactic use of antibiotics in cell culture as well as their effects on cells. The influence of antibiotics on cell morphology, cellular degeneration and cell death and cellular function is summarized. Cellular DNA as well as protein synthesis are affected which can lead to interference with, or even changes in, metabolic processes. Such effects must be considered in cell culture research. As antibiotics are used in multifold ways, the otherwise standardized conditions in cell culture are no longer comparable. The prophylactic use of antibiotics is rejected for scientific reasons.     

The treatment of malaria.

At least four doses of quinine followed by a single dose of mefloquine or by a single dose of sulfadoxine-pyrimethamine are two highly effective regimens for chloroquine-resistant falciparum malaria. Mefloquine alone is valuable in ambulant patients. Chloroquine-sensitive falciparum malaria can be treated with a course of chloroquine. Vivax and all other types of malaria should be treated with sequential chloroquine and primaquine. Quinine, by intravenous infusion, is the most effective drug for severe falciparum malaria. The optimum intravenous dose varies between 5 mg/kg and 10 mg/kg administered over four hours. Intravenous or oral quinine should be administered about every 12 hours and the total daily dose of quinine should rarely exceed 20 mg/kg. Intravenous fluid input should be controlled in falciparum malaria to prevent pulmonary oedema. Established renal failure is best treated by dialysis. The value of adrenocortical steroids for falciparum coma has not been established. Fresh blood transfusion may be helpful in small doses for severe anaemia and to replace clotting factors. Anticoagulants, such as heparin, should not be used in falciparum malaria.     

The treatment of falciparum malaria

Effective treatment for falciparum malaria has been available for over 300 years, and for most of this time physicians have argued over the best doses and the methods of administering antimalarial drugs. A reasonable consensus has since emerged on the treatment of uncomplicated malaria, but there is still disagreement over the management of severe infections, and as a consequence there have been confusing and dangerous discrepancies in treatment recommendations. In this review, Nicholas White discusses the confusion, offering a rational basis for the clinical treatment of both uncomplicated and severe falciparum malaria.     

The use of antibiotics in the culture of non-sterile plant protoplasts

Summary The use of antibiotics to control infections in cultures of protoplasts of leaf mesophyll cells has been examined. The antifungal agents nystatin and amphotericin B were non-toxic to protoplasts at concentrations that controlled fungal growth (25 units and 2.5 g/ml respectively). Of the antibacterial agents examined, only carbenicillin and, to a lesser extent, gentamicin were active against the bacteria usually encountered whilst still permitting normal protoplast metabolism and regeneration. The most satisfactory control of contaminating microorganisms was obtained with a combination of nystatin (25 units/ml) or amphotericin B (2.5 g/ml) and carbenicillin (250 g/ml).     

Immucillins as antibiotics for T-cell proliferation and malaria

The genetic deficiency of human PNP causes a specific immunodeficiency by inducing apoptosis in dividing T-cells. Powerful inhibitors of PNP have been designed from the experimental determination of the transition state structure of PNPs. The Immucillins are transition state analogue inhibitors with Kd values as low as 7 pM. In the presence of deoxyguanosine the Immucillins kill activated human T-cells but not other cell types. The Immucillins are orally available and of low toxicity to mice. Immucillins also inhibit PNP from Plasmodium falciparum. Parasites cultured in human erythrocytes are killed by purine starvation in the presence of Immucillins and can be rescued by hypoxanthine.     

Consequences of the widespread use of antibiotics

The cancer problem is increasing as life expectancy increases and greater portions of the populace live to the age at which cancer is more likely. Early diagnosis still is difficult. Even with modern methods and with considerable public education with regard to cancer, the disease is often not diagnosed until it is beyond the stage at which cure might be effected. The need for a serodiagnostic test for general screening purposes for cancer detection is tremendous. The major objective of cancer serodiagnostic test methods is to discover a general test that will detect cancer in a high percentage of cases while it is in an early stage; that will give few "false positive" results; that can be done in any laboratory; and that is simple and inexpensive. Many serodiagnostic tests for cancer have been published but none has proven worthy of being a good general test to detect cancer. Yet unless some serodiagnostic test which will be suitable for general screening purposes is developed, it is difficult to see how there can be much improvement in the early diagnosis of cancer, particularly internal cancer. It is hoped that an open-minded attitude will be maintained by physicians on this subject. Recent reports of such a test being developed are encouraging and it is hoped that continued investigations will be confirmatory.