Efficacy and Safety of Artesunate-Amodiaquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium falciparum Malaria in Sentinel Sites across Côte d'Ivoire.

William Yavo,Vincent Djohan,Fulgence Kondo Kassi,Abibatou Konaté,Pulcherie Christiane Kiki-Barro,Henriette Vanga-Bosson,Eby Ignace Hervé Menan,Etienne Kpongbo Angora

doi:10.1155/2015/878132

Abstract

Two years after the introduction of free Artesunate-Amodiaquine (ASAQ) and Artemether-Lumefantrine (AL) for the treatment of uncomplicated malaria in public health facilities in Côte d'Ivoire, we carried out this study to compare their efficacy and tolerability in three surveillance sites. It was a multicentre open randomised clinical trial of 3-day ASAQ treatment against AL for the treatment of 2 parallel groups of patients aged 2 years and above. The endpoints were (1) Adequate Clinical and Parasitological Response (ACPR) at day 28 and (2) the clinical and biological tolerability. Of the 300 patients who were enrolled 289, with 143 (49.5%) and 146 (50.5%) in the ASAQ and AL groups, respectively, correctly followed the WHO 2003 protocol we used. The PCR-corrected ACPR was 99.3% for each group. More than 94% of patients no longer showed signs of fever, 48 hours after treatment. Approximately 78% of the people in the ASAQ group had a parasite clearance time of 48 hours or less compared to 81% in the AL group (p = 0.496). Both drugs were found to be well tolerated by the patients. This study demonstrates the effectiveness and tolerability of ASAQ and AL supporting their continuous use for the treatment of uncomplicated P. falciparum malaria infection in Côte d'Ivoire.

Highlights

Malaria remains a serious health concern in sub-Saharan Africa [1]
The density of P. falciparum in the peripheral blood was determined by counting the number of asexual parasites in 200 white blood cells (WBC)
A total of 300 patients were included in the study. 151 patients were randomized to ASAQ and 149 to AL

Summary

Introduction

Malaria remains a serious health concern in sub-Saharan Africa [1]. In Cote d’Ivoire, malaria accounts for 43% of outpatient visits with one-third of reported death in health facilities [2]. Due to the development and increasing resistance of P. falciparum to various antimalarial drugs available, the WHO introduced and recommended the use of artemisinin-based combination therapy (ACT) for the treatment of malaria [3, 4]. This recommendation was adopted by Cote d’Ivoire in 2007 [5]. Self-medication, poor adherence to treatment, counterfeit drugs, and human and Plasmodium genetic makeup may influence the efficacy and safety profiles of ACTs in Cote d’Ivoire

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Methods

Conclusion