Abstract
BackgroundAnti-malarial drug resistance continues to be a leading threat to ongoing malaria control efforts and calls for continued monitoring of the efficacy of these drugs in order to inform national anti-malarial drug policy decision-making. This study assessed the therapeutic efficacy and safety of artemether-lumefantrine (AL)(Coartem®) for the treatment of uncomplicated Plasmodium falciparum malaria in two sentinel high malaria transmission districts in the Eastern Province of Zambia in persons aged six months and above, excluding women aged 12 to 18 years.MethodsThis was an observational cohort of 176 symptomatic patients diagnosed with uncomplicated Plasmodium falciparum mono-infection. A World Health Organization (WHO)-standardized 28-day assessment protocol was used to assess clinical and parasitological responses to directly observed AL treatment of uncomplicated malaria. DNA polymerase chain reaction (PCR) analysis for molecular markers of AL resistance was conducted on positive blood samples and differentiated recrudescence from re-infections of the malaria parasites.ResultsAll patients (CI 97.6-100) had adequate clinical and parasitological responses to treatment with AL. At the time of enrolment, mean slide positivity among study participants was 71.8% and 55.2% in Katete and Chipata, respectively. From a mean parasite density of 55,087, 98% of the study participants presented with zero parasitaemia by day 3 of the study. Fever clearance occurred within 24 hours of treatment with AL. However mean parasite density declines were most dramatic in participants in the older age. No adverse reactions to AL treatment were observed during the study.ConclusionAL remains a safe and efficacious drug for the treatment of uncomplicated Plasmodium falciparum malaria in Zambia, endemic for malaria, with some provinces experiencing high transmission intensity. However, the delayed parasite clearance in younger patients calls for further sentinel and periodical monitoring of AL efficacy in different areas of the country.
Highlights
Anti-malarial drug resistance continues to be a leading threat to ongoing malaria control efforts and calls for continued monitoring of the efficacy of these drugs in order to inform national anti-malarial drug policy decision-making
AL is recommended for the treatment of uncomplicated malaria because of its rapid reduction of parasite load as a result of the action of the artemisinin component and continued elimination of residual parasites by lumefantrine which results in a rapid clinical response [6,7]
Study population The population consisted of consenting patients with uncomplicated Plasmodium falciparum malaria infection seeking care at the selected study primary health care facilities who were aged six months (>5kgs weight) and above, excluding women of the age group 12 to 18 years as requesting this age group to take a pregnancy test and initiate contraception is not acceptable in the local context
Summary
Anti-malarial drug resistance continues to be a leading threat to ongoing malaria control efforts and calls for continued monitoring of the efficacy of these drugs in order to inform national anti-malarial drug policy decision-making. Continued success in controlling malaria continues to be threatened by the development of resistance to anti-malarial medicines, as evidenced in Zambia with resistance development to chloroquine and sulphadoxinepyrimethamine [4,5]. In this regard, following recommendations by the World Health Organization (WHO) [6,7], Zambia reviewed its malaria treatment policy in 2003 removing Chloroquine (CQ) as the first-line treatment for uncomplicated malaria and replaced it with artemisinin combination therapy (ACT), with the drug of choice being the co-formulated artemether-lumefantrine (AL) (20 mg artemether and 120 mg lumefantrine) [5]. ACT may reduce the development of parasite resistance subsequently by contributing to the reduction of malaria transmission [8]
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