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WHO reported that the efficacy of artemisinin combination-based therapies (ACTs) has decreased around the Thai-Cambodian border. To maintain the efficacy and prolong the life span of ACTs, malarone (an atovaquone and proguanil combination) has been administered in Trat and Chanthaburi Provinces of Thailand since 2009. The mutations of codons 133, 258, 268, 272, 275, 280, 283, and 284 in the cytochrome b gene have been reported to be related to malarone resistance. This study investigates the susceptibility in vitro and mutations in the cytochrome b gene before and after the administration of malarone. Plasmodium falciparum infected blood samples obtained from malaria patients attending malaria clinics in these two provinces were included in this study. Fifteen parasite isolates were subjected to in vitro susceptibility tests against atovaquone. Their mean inhibitory concentrations ranged from 5 10 9 -5 10 10 M. The DNA sequences from 37 PCR samples revealed no mutations. Therefore the variation of drug susceptibility among these parasites may be unrelated to point mutations in the cytochrome b gene.

Cytochrome b mutation and atovaquone susceptibility in Plasmodium falciparum isolates from the Thai-Cambodian border during 1990–2010