Abstract
BackgroundThe national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013–2014).MethodsGiemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000–10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance).ResultsA total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level.ConclusionOnly one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.
Highlights
The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004
According to the World Health organization (WHO), in 2016 it was estimated that 445,000 people died from malaria and 216 million people were infected with malaria
Polymerase Chain Reaction (PCR) analyses of filter paper blood samples for Klech 13 (K13) mutation at Mahidol University, Bangkok, Thailand showed all the parasites were of wild type and had no detectable mutation on K13 region. This is a first study in Nepal assessing the therapeutic efficacy of ACTs to inform the national malaria treatment guidelines
Summary
The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Artemisinin or its derivatives or Artemisinin in combination with other drugs, is used as a first line drug for the treatment of uncomplicated falciparum malaria in many countries [5]. In Nepal, a combination of artemether and lumefantrine—called as Artemisinin Combination Therapies (ACTs) have been used as a first line drug for the treatment of falciparum malaria since 2004 [6, 7]. The emergence of ACTs resistance in GMS and its potential spread may become a public health disaster [9, 10]. Continuous monitoring of efficacy of antimalarials (ACTs) is critical as malaria control programs in nations including Nepal rely on it as a first line treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
