Gametocytocidal clearance by artemether–lumefantrine versus artesunate–amodiaquine in North-Central Nigeria

Abstract

Background: The deployed artemether–lumefantrine (AL) and artesunate–amodiaquine (AA) medicines are known to be gametocytocidal. Continuous monitoring of their efficacies is imperative for malaria elimination interventions. To compare gametocytocidal clearance by AL versus AA. Materials and Methods: Data on demographics, anthropometry measures and gametocytes densities of 111 of 114 Human Immunodeficiency Virus (HIV) sero-negative children aged 6–59 months with uncomplicated Plasmodium falciparum malaria mono-infection, who participated in a drug therapeutic efficacy testing, were extracted. Patients who had severe malnutrition, other causes of common childhood fevers and use of antimalarial medicines in the preceding 1 week were excluded from the study. Study participants who met the enrolment criteria and gave written informed parental consent were randomized to receive AL or AA according to the manufacturer’s instructions. Clinical and parasitological evaluations were performed on D0, D1, D2, D3, D7, D14, D21 and D28. Analysis was restricted to 111 participants who completed the study. Results: Twelve (10.8%) patients had gametocytes on D0. Six (5.4%) study participants were in the AL treatment arm and 6 (5.4%) participants were in the AA treatment arm (P = 0.32). Gametocyte clearance time (GCT)AL was 104 h and (GCT)AA was 152 h (P = 0.44). Conclusion: AL and AA demonstrated comparable gametocytocidal activity in North-Central Nigeria. There is a need for continuous monitoring of the efficacies of these artemisinin-based combination therapies to keep track with the emergence of resistant Plasmodium gametocyte isolates in Nigeria.