Abstract
BackgroundDue to increasing drug resistance, artemisinin-based combination chemotherapy (ACT) has become the first-line treatment of falciparum malaria in many endemic countries. However, irreversible ototoxicity associated with artemether/lumefantrine (AL) has been reported recently and suggested to be a serious limitation in the use of ACT. The aim of the study was to compare ototoxicity, tolerability, and efficacy of ACT with that of quinine and atovaquone/proguanil in the treatment of uncomplicated falciparum malaria.MethodsNinety-seven patients in south-west Ethiopia with slide-confirmed malaria were randomly assigned to receive either artemether/lumefantrine or quinine or atovaquone/proguanil and followed-up for 90 days. Comprehensive audiovestibular testing by pure tone audiometry (PTA), transitory evoked (TE) and distortion product (DP) otoacoustic emissions (OAE) and brain stem evoked response audiometry (BERA) was done before enrolment and after seven, 28 and 90 days.ResultsPTA and DP-OAE levels revealed transient significant cochlear hearing loss in patients treated with quinine but not in those treated with artemether/lumefantrine or atovaquone/proguanil. TE-OAE could be elicited in all examinations, except for three patients in the Q group on day 7, who suffered a transient hearing loss greater than 30 dB. There was no evidence of drug-induced brain stem lesions by BERA measurements.ConclusionThere was no detrimental effect of a standard oral regimen of artemether/lumefantrine on peripheral hearing or brainstem auditory pathways in patients with uncomplicated falciparum malaria. In contrast, transient hearing loss is common after quinine therapy and due to temporary outer hair cell dysfunction.
Highlights
Due to increasing drug resistance, artemisinin-based combination chemotherapy (ACT) has become the first-line treatment of falciparum malaria in many endemic countries
Due to increasing resistance of Plasmodium falciparum strains against chloroquine and sulphadoxine/pyrimethamine, several Asian and African countries have changed their national policy towards first-line treatment with artemisinin-based combination chemotherapies (ACT) as recommended by current WHO guidelines [1,2]
The first-line treatment of uncomplicated falciparum malaria changed from sulphadoxine/ pyrimethamine to AL in Ethiopia in 2004 [14]
Summary
Due to increasing drug resistance, artemisinin-based combination chemotherapy (ACT) has become the first-line treatment of falciparum malaria in many endemic countries. Irreversible ototoxicity associated with artemether/lumefantrine (AL) has been reported recently and suggested to be a serious limitation in the use of ACT. Due to increasing resistance of Plasmodium falciparum strains against chloroquine and sulphadoxine/pyrimethamine, several Asian and African countries have changed their national policy towards first-line treatment with artemisinin-based combination chemotherapies (ACT) as recommended by current WHO guidelines [1,2]. Ototoxicity has been reported in association with the use of quinoline type antimalarials [10,11], and quinine since long is known to cause reversible hearing loss and tinnitus[12]. Audiometric testing (duration 1–1.5 h) of eligible patients at enrolment was completed before starting antimalarial 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
