THERAPEUTIC DOSES OF CIPROFLOXACIN DO NOT ENHANCE PARASITE CLEARANCE OF ARTEMETHER -LUMEFANTRINE OR ARTESUNATE-AMODIAQUINE COMBINATIONS IN MICE

Background: Resistance to recommended Artemisinin-based Combination Therapy (ACT) by malaria parasite is a major public health concern. To prevent treatment failures, some clinicians in developing countries combine ACT with Ciprofloxacin in the treatment of suspected or confirmed malaria infection. This study assesses the role of therapeutic doses of Ciprofloxacin (CIP) in combination with commonly used ACTs, namely Artesunate/Amodiaquine (AS/AQ) and Artemether/Lumefantrine (AT/LM), on parasite clearance in animal model of malaria infection.

Methods: Using established animal model of malaria infection, infected albino mice were treated with therapeutic doses of ACTs with and without therapeutic doses of CIP. The parasite clearance rates of the respective combinations (AQ/AS; AS/AQ/CIP; AT/LM/CIP; and AT/LM) were serially determined.

Results: Parasite clearances were similar in groups with or without CIP. More than 80% parasite clearance was noted on Day 4 for both ACTs/CIP and ACTs alone. Survival was reduced in ACTs/CIP (80%) compared to ACTs alone (100%).

Conclusion: This preclinical study demonstrated that Ciprofloxacin at clinical doses does not improve parasite clearance in combination with either AT/LM or AQ/AS and may be potentially harmful. This report raises concern for the therapeutic benefit of CIP in the treatment of malaria and warrant further evaluation.