Abstract
BackgroundThe recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence.MethodsThis study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon.ResultsForty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n = 38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study.ConclusionsThis first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon.Trial RegistrationClinicalTrials.gov Identifier: NCT00725777
Highlights
The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials
Today Plasmodium ovale and Plasmodium malariae are among the most neglected tropical diseases in sub-Saharan Africa. This fact is illustrated by an analysis of clinical trials on P. ovale and P. malariae malaria resulting in less than five interventional clinical trials over the past 10 years, compared to 930 reports of clinical trials for P. falciparum malaria [4]
Since artemetherlumefantrine is used on a large scale for these indications in sub-Saharan Africa we assessed the efficacy of artemether-lumefantrine in patients suffering from uncomplicated malaria due to non-falciparum species or mixed malaria species infections presenting at two district hospitals in the Central African country of Gabon. This prospective study was performed in Gabon at the Medical Research Unit of the Albert Schweitzer Hospital in Lambaréné [9] and the Regional Hospital of Fougamou. This Central African region is characterized by perennial transmission of P. falciparum [10] and co-endemicity of P. ovale and P. malariae [5]
Summary
The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. A plethora of clinical trials demonstrating high efficacy, satisfying effectiveness, and good tolerability and safety of artemisinin combination therapy (ACT) – the current first-line treatment of falciparum malaria – has been conducted and published over the past decade [1,2]. Today Plasmodium ovale and Plasmodium malariae are among the most neglected tropical diseases in sub-Saharan Africa This fact is illustrated by an analysis of clinical trials on P. ovale and P. malariae malaria resulting in less than five interventional clinical trials over the past 10 years, compared to 930 reports of clinical trials for P. falciparum malaria [4]. More research activities are needed to boost the development of novel and improved control tools for these plasmodial infections
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