Clinical Efficacy of Artemether-Lumefantrine in Congolese Children with Acute Uncomplicated Falciparum Malaria in Brazzaville

Ndounga, Mathieu; Tahar, Rachida; Casimiro, Prisca Nadine; Loumouamou, Dieudonné; Basco, Léonardo K.

doi:10.1155/2012/749479

Cited by 7 publications

(18 citation statements)

References 9 publications

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“…P. falciparum is the usual cause of recrudescent infections as it can remain in blood stream due to ineffective treatment or host immunity. 8,16 In our patients, 10 (14.2 %) had an average of 11 prior malarial attacks treated within the previous 64 days (7-180 days) before the last presentation; nine of them had received their last malarial episode within the previous month (recrudescence). Three patients had received previous treatments of 3-day artemether-lumefantrine and two had received quinine.…”

Section: Discussionmentioning

confidence: 84%

Imported Plasmodium falciparum malaria in Istanbul, Turkey: risk factors for severe course and mortality

et al. 2013

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We describe the epidemiological, clinical features and risk factors for the morbidity and mortality of imported Plasmodium falciparum malaria cases during the last 10 years in Istanbul, Turkey. The epidemiological, clinical and laboratory data of cases in six tertiary care hospitals in Istanbul between 2002 and 2012 were analysed. Seventy patients (65 males, five females; median age 37; range: 14-84) were included. Sixty-five (93%) patients had travelled to African countries and the remaining five to other malarious countries. Seventeen (24%) had a history of previous malarial episodes; eight (13%) developed recrudescence during the first month; 22 (31%), 17 (24%), 20 (29%) and three (4%) cases had cerebral malaria, cholestatic icterus, malarial hepatitis and respiratory distress syndrome on admission, respectively. Six of 12 patients with severe falciparum malaria died. Clinically, the presence of alteration in mental status, icterus, hypoglycaemia, disseminated intravascular coagulation and malarial hepatitis were statistically significant for the development of severe malaria and mortality. Recrudescence should not be forgotten, especially in uncomplicated cases.

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Section: Discussionmentioning

confidence: 84%

Imported Plasmodium falciparum malaria in Istanbul, Turkey: risk factors for severe course and mortality

et al. 2013

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“…Per-protocol (PP) data were analysed using a pre-programmed Excel 7 spreadsheet provided by the Department of Global Malaria Programme, WHO (Geneva, Switzerland). This analysis method allows a direct comparison of data of the present study with those of previous studies [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 89%

“…In 2006, RoC adopted a new treatment policy for uncomplicated malaria with artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) as the first- and second-line drugs, respectively [ 15 ]. Three clinical studies were conducted before the decision: one randomized study in a rural area near Brazzaville [ 16 ] and two non-randomized studies in Brazzaville [ 17 , 18 ]. In these three published studies, non-co-formulated drugs were administered to symptomatic patients.…”

Section: Introductionmentioning

confidence: 99%

Artesunate-amodiaquine versus artemether-lumefantrine for the treatment of acute uncomplicated malaria in Congolese children under 10 years old living in a suburban area: a randomized study

Ndounga¹,

Mayengue²,

Casimiro³

et al. 2015

Malar J

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BackgroundThe Republic of Congo adopted a new anti-malarial treatment policy in 2006, with artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) as the first- and second-line anti-malarial drugs, respectively. Only three clinical studies had been conducted before the policy change. A randomized study on these two artemisinin-based combinations was conducted, and the effect that sickle cell trait may have on treatment outcomes was evaluated in children under 10 years old followed during 12 months in Brazzaville in 2010–2011.MethodsA cohort of 330 children under 10 years of age living in a suburban area in the south of Brazzaville were passively followed for registration of malaria episodes. Uncomplicated Plasmodium falciparum episodes were randomly treated with co-formulated ASAQ (Coarsucam®) or AL (Coartem®). Patients were followed according to the 2009 World Health Organization protocol for the evaluation of anti-malarial drug efficacy. Plasmodium falciparum recrudescent isolates were compared to pre-treatment isolates by polymerase chain reaction (PCR) to distinguish between re-infection and recrudescence. PCR-uncorrected and PCR-corrected responses to treatment were determined using per protocol analysis. Haemoglobin type (AA, AS, SS) was determined by PCR.ResultsOf 282 clinical malaria episodes registered during 1-year follow-up period, 262 children with uncomplicated malaria were treated with ASAQ (129 patients) or AL (133 patients). The PCR-corrected efficacy, expressed as the percentage of adequate clinical and parasitological response, was 97.0 % for ASAQ and 96.4 % for AL. Among ASAQ-treated patients, 112 (86.8 %) carried AA genotype and 17 (13.2 %) were AS carriers. The PCR-corrected efficacy was 96.4 % for AA-carriers and 100 % for AS-carriers treated with ASAQ [relative risk (RR) = 0.96; 95 % confidence interval, 0.93–1.00, p = 0.5]. Among 133 AL-treated children, 109 (82 %) carried AA, and 24 (18 %) AS genotypes. The PCR-corrected efficacy was 96.7 % among AA-carriers and 95.2 % among AS-carriers [RR = 1.01 (0.92–1.12), p = 0.6]. Nausea, jaundice, headache, dizziness, vomiting, pruritus, abdominal pain, and diarrhoea were registered as adverse events in both groups. ASAQ was associated with significantly more frequent adverse events (P < 0.05).ConclusionThis first randomized study in Brazzaville confirmed the excellent efficacy of these co-formulated anti-malarial drugs in children. Sickle cell genotype did not influence the treatment efficacy of artemisinin-based combination therapy.

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“…In the period 1992 to 2005, before adoption of ACTs, six efficacy in vivo studies had been conducted, of which one was based on the 1973 WHO protocol for asymptomatic children to assess chloroquine efficacy [20], one on 14-day follow-up WHO protocol to assess chloroquine and sulfadoxine-pyrimethamine (SP) [22], and four on the current 28-day follow-up WHO protocol to evaluate therapeutic efficacy of chloroquine [24], SP [25], ASAQ, AL and AS + SP [26], AL and then ASAQ [28, 30]. The study based on the 1973 WHO protocol was conducted in 1993 in three southern regions of the country (Niari, Kouilou and Pool which included Brazzaville) and the authors reported that 7 days after the standard three-day treatment with chloroquine at 25 mg/kg, 20–60% of cases were still found to carry malaria parasites [20].…”

Section: Resultsmentioning

confidence: 99%

“…SP efficacy was further assessed in the second phase of this study and the cure rate of 100% was recorded [22]. However, studies carried out using the 28-day follow-up WHO protocol showed high level of treatment failure for chloroquine (95.7%) [24] and SP (31.2%) [25], while AL and ASAQ were found to be highly effective to treat uncomplicated malaria with the reported 28-day PCR-corrected cure rates of 96.9 [30] and 100% [26] for AL, and 94.4% [28] and 98.5% [26] for ASAQ. AS + SP, with the 28-day PCR-corrected cure rate of 90% was also effective but less than AL and ASAQ [26].…”

Section: Resultsmentioning

confidence: 99%

Malaria epidemiological research in the Republic of Congo

Koukouikila-Koussounda

Ntoumi

2016

Malar J

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BackgroundReliable and comprehensive information on the burden of malaria is critical for guiding national and international efforts in malaria control. The purpose of this review is to provide an overview of published data and available information on malaria resulting from field studies/investigations conducted in the Republic of Congo (RoC) from 1992 to 2015, as baseline for assisting public health authorities and researchers to define future research priorities as well as interventions.MethodsThis review considers data from peer-reviewed articles and information from the National Malaria Control Programme reports, based on field investigations or samples collected from 1992 to 2015. Peer-reviewed papers were searched throughout online bibliographic databases PubMed, HINARI and Google Scholar using the following terms: “malaria”, “Congo”, “Brazzaville”, “prevalence”, “antimalarial”, “efficacy”, “falciparum”, “genetic”, “diversity”. Original articles and reviews were included and selection of relevant papers was made.ResultsTwenty-eight published articles were included in this review and two additional records from the National Malaria Control Programme were also considered. The majority of studies were conducted in Brazzaville and Pointe-Noire.ConclusionThe present systematic review reveals that number of studies have been conducted in the RoC with regard to malaria. However, their results cannot formally be generalized at the country level. This suggests a need for implementing regular multisite investigations and surveys that may be representative of the country, calling for the support and lead of the Ministry of Health.

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Clinical Efficacy of Artemether-Lumefantrine in Congolese Children with Acute Uncomplicated Falciparum Malaria in Brazzaville

Cited by 7 publications

References 9 publications

Imported Plasmodium falciparum malaria in Istanbul, Turkey: risk factors for severe course and mortality

Imported Plasmodium falciparum malaria in Istanbul, Turkey: risk factors for severe course and mortality

Artesunate-amodiaquine versus artemether-lumefantrine for the treatment of acute uncomplicated malaria in Congolese children under 10 years old living in a suburban area: a randomized study

Malaria epidemiological research in the Republic of Congo

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