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Mixed-drug approach to malaria

Wednesday March 28th, 2018

A drug used to treat parasitic diseases is also effective at controlling mosquitoes, British researchers report today.

Results of a new study suggest that adding high-dose ivermectin to a standard malaria treatment (dihydroartemisinin-piperaquine) in community-wide campaigns such as mass drug administration, could reduce malaria rates by up to 61%.

Furthermore, in areas where only 10% of the population is infected with malaria, adding ivermectin could reduce rate to less than 0.1% for more than six months, say Dr Menno Smit of Liverpool School of Tropical Medicine, UK, and colleagues.

They publish their results today (28 March) in The Lancet Infectious Diseases.

Some 141 adults treated for malaria in Kisumu, Kenya, took part in the randomised trial.

The researchers tested the treatment in laboratory conditions, feeding the blood from patients to mosquitoes. They found that patients treated with low dose ivermectin had blood that killed the creatures four times faster than blood from those treated with placebo.

Dr Smit said: "This is the first study to show the safety and efficacy of multiple high-doses of ivermectin on mosquito mortality. Our results suggest that a 300 microgram per kg dose of ivermectin each day for three days would provide a good balance between efficacy and tolerability."

He adds: "Despite these encouraging findings, further rigorous safety and efficacy trials in younger age groups are needed before high-dose ivermectin can be administered at scale to assess its impact on malaria transmission and human health.

"High-dose ivermectin may also have potential applications in other vector-borne diseases transmitted by mosquitoes including Zika virus, dengue, and West Nile fever, as well as insect- and tick-borne disease like sleeping sickness and Lyme disease.

“Further studies should be done to assess the use of high-dose ivermectin against these insects."

Over 2.5 billion doses of ivermectin have been given across Africa and Latin America to kill parasitic worms, including those that cause river blindness and lymphatic filariasis, and has been shown to be safe, the team states.

Smit, M. et al. Safety and mosquitocidal efficacy of high-dose ivermectin when co-administered with dihydroartemisinin-piperaquine in Kenyan adults with uncomplicated malaria (IVERMAL): a randomised, double-blind, placebo-controlled trial. The Lancet Infectious Diseases 28 March 2018; doi: 10.1016/S1473-3099(18)30163-4

Link: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30163-4/fulltext

Tags: Pharmaceuticals | UK News | World Health

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