Therapeutic efficacy and effect on gametocyte carriage of an artemisinin and a non-based combination treatment in children with uncomplicated P. falciparum malaria, living in an area with high-level chloroquine resistance

Abstract

Combination therapy with artemesinin or non-artemesinin-based antimalarials (ACTs or NACTs) are known to retard the development and progression of drug resistance in Plasmodium falciparum (P. falciparum). The optimal antimalarial combinations in Africa are yet unknown. We evaluate the therapeutic efficacy and effects on gametocyte carriage of Artemether-Lumefantrine (AL) and Amodiaquine-Sulfalene/Pyrimethamine (ASP) in children with P. falciparum malaria in an endemic area. One-hundred and thirty-nine children aged ≤ 10 years with uncomplicated P. falciparum malaria were enrolled. The primary end points were adequate clinical and parasitological response (ACPR), late parasitological failure(LPF), late clinical failure (LCF) and early treatment failure (ETF). Polymerase chain reaction (PCR)-corrected cure rates on days 14-42 and gametocyte carriage rates were determined. Fever clearance time was significantly shorter (P = 0.009) with ASP, but parasite clearance time was similar with both regimens. Day 28 cure rates were 91.4 and 89.9% (PCR-corrected) for AL and ASP respectively. Both regimens were well tolerated. Overall, gametocyte carriage before and following treatment were similar. Both combinations were found effective and comparable for treatment of acute, uncomplicated, P. falciparum malaria.