A needed review on parasite clearance

The parasite clearance curve and, the more commonly used, parasite clearance time is a measure of the reduction of parasite density over time or the time until the patient is parasite free, after beginning treatment. Interest in parasite clearance has peaked as a means to gauge artemisinin resistance (previously discussed here and here) as combination therapies often have few outright failures and other tools to detect early resistance such as in vitro tests and molecular markers are not useful or possible at this time.

Professor Nick White, one of the world’s foremost experts in treating malaria, just published a fantastic review (Malaria Journal – open access!) on the topic. The article presents a great discussion of  measurement issues and common limitations, analyzing by density reduction or time until clearance, the kinetics and trend of results, connections with stage-specific action, and much more. As we’re in the midst of analyzing two years of artesunate+sulphadoxine-pyrimethamine trial data from India’s National Antimalarial Therapeutic Efficacy Monitoring Network, we’re fortunate for the release of the article since examining the parasite clearance in our patients is one of the key concerns.

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