Widespread Availability of Artemisinin Monotherapy in the United States | CDC EID

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Volume 17, Number 5–May 2011
Letter
Widespread Availability of Artemisinin Monotherapy in the United States
Robert M. Rakita and Uma Malhotra
Author affiliations: University of Washington, Seattle, Washington, USA (R.M. Rakita); and Virginia Mason Medical Center, Seattle (U. Malhotra)


Suggested citation for this article

To the Editor: Artemisinin-based combination therapies are recommended as first line treatments for Plasmodium falciparum malaria in most areas of the world. The article by Shahinas et al. (1) describes a patient who had P. falciparum malaria after returning from Nigeria. Her isolate had an elevated 50% inhibitory concentration to artemisinin derivatives. She had obtained artesunate in Nigeria and took it weekly for malaria prophylaxis, which might have contributed to the relative resistance found.

Figure

Figure. Bottle of artemisinin, available over-the-counter as an herbal supplement.


In 2009, one artemisinin-based combination therapy (artemether/lumefantrine) became available for use in the United States. However, it is not widely appreciated that artemisinin is actually available in the United States as an herbal supplement for over-the-counter purchase (2). It is marketed for general health maintenance and for treatment of parasitic infections and cancers (Figure), although as with other supplements it is not intended to diagnose, treat, cure, or prevent any disease. As in the patient described by Shahinas et al., widespread use of artemisinin or its derivatives as monotherapies could potentially lead to progressively increasing resistance in P. falciparum malaria (3). Studies in western Cambodia, where artemisinin monotherapy has been available for many years, have revealed in vivo artesunate resistance, with markedly decreased parasite clearance times (3). Progressive spread of artemisinin resistance could have disastrous consequences for the global control of malaria. Thus, minimally regulated use of potent compounds in dietary supplements has the potential for major public health implications.

References
1.Shahinas D, Lau R, Khairnar K, Hancock D, Pillai DR. Artesunate misuse and Plasmodium falciparum malaria in traveler returning from Africa. Emerg Infect Dis. 2010;16:1608–10.
2.Malhotra U, Rakita R, Fernandez F, Harris G, Arguin P, Bronzan R, et al. Hepatitis temporally associated with an herbal supplement containing artemisinin—Washington, 2008. MMWR Morb Mortal Wkly Rep. 2009;58:854–6.
3.Dondorp AM, Nosten F, Yi P, Das D, Phyo AP, Tarning J, et al. Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2009;361:455-67.
Figure
Figure. Bottle of artemisinin, available over-the-counter as an herbal supplement.

Suggested Citation for this Article
Rakita RM. Widespread availability of artemisinin monotherapy in the United States [letter]. Emerg Infect Dis [serial on the Internet]. 2011 May [date cited]. http://www.cdc.gov/EID/content/17/5/954.htm

DOI: 10.3201/eid1705.101532


Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Robert M. Rakita, University of Washington, 1959 NE Pacific, Box 356175 Seattle, WA 98195, USA; email: rakita@u.washington.edu


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Widespread Availability of Artemisinin Monotherapy in the United States | CDC EID