Efficacy of artemether-lumefantrine as a treatment for uncomplicated Plasmodium vivax malaria in eastern Sudan

Abdallah, Tajeldin M.; Ali, AbdelAziem A.; Bakri, Mohammed Hariri; Gasim, Gasim I.; Musa, Imad R.; Adam, Ishag

doi:10.1186/1475-2875-11-404

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…Wild type genotypes at these two loci have significantly recovered, which provides supporting evidence that CQ use has been successfully reduced [70]. Interestingly the multiple copy pfmdr1 genotype previously reported from eastern Sudan [30] was not observed here.…”

Section: Discussionsupporting

confidence: 79%

Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan

Gadalla

Abdallah

Atwal

et al. 2013

Malar J

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BackgroundArtesunate/sulphadoxine-pyrimethamine (AS/SP) has been the first-line treatment for falciparum malaria in Sudan since 2004. The impact of this combination on anti-malarial resistance-associated molecular markers has not been investigated. In this study, an evaluation of the efficacy and prevalence of drug resistance alleles (pfcrt, pfmdr1, pfdhfr and pfdhps) eight years after the adoption of AS/SP in eastern Sudan is reported.MethodsA 28-day follow-up efficacy trial of AS/SP was conducted in eastern Sudan during the 2012 transmission season. Blood smears were collected from patients on days 0, 1, 2, 3, 7, 14, 21 and 28. Blood spots on filter paper were obtained pre-treatment and on the day the patient was parasite positive by microscopy. Genotyping of alleles was performed by qPCR (pfcrt 72–76 and pfmdr1 copy number) and direct sequencing of pfmdr1, pfdhfr and pfdhps.ResultsSixty-three patients out of 68 (93%) completed the 28-day follow-up, adequate clinical, and parasitological response occurred in 90.5% and 85.3% of the patients in the per-protocol and intent-to-treat analyses, respectively. PCR corrected per-protocol efficacy was 93.7%. The enrolment prevalence of pfcrt-CVMNK was 30.2% and pfmdr1-N86 was 40.3%. The pfmdr1 haplotype NFD occurred in 32.8% of pre-treatment samples and was significantly higher than previous reports (Fisher’s exact p = 0.0001). The pfdhfr-51I/108N combination occurred in all sequenced isolates and 59R was observed in a single individual. pfdhps substitutions 436A, 437G, 540E, 581G and 613S were observed at 7.8, 77.3, 76.9%, 33.8% and 0.0%, respectively. Treatment failures were associated with the pfdhps haplotype SGEGA at these five codons (OR 7.3; 95% CI 0.65 - 368; p = 0.048).ConclusionThe decrease of CQR associated genotypes reflects the formal policy of complete removal of CQ in Sudan. However, the frequency of markers associated with SP failure is increasing in this study area and may be contributing to the treatment efficacy falling below 90%. Further monitoring of AS/SP efficacy and of post-treatment selection of pfdhfr and pfdhps alleles in vivo is required to inform future treatment guidelines.

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Section: Discussionsupporting

confidence: 79%

Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan

Gadalla

Abdallah

Atwal

et al. 2013

Malar J

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“…In all trials comparing ACT with CQ, serious adverse events were rare. ACT has also been investigated in non-randomized clinical trials with AL[ 32 , 45 – 47 ] and injectable artesunate (for severe P. vivax malaria)[ 25 , 26 , 41 , 42 , 48 , 49 ], all showing relative short parasite and fever clearance times and excellent day 28 cure rates.…”

Section: Resultsmentioning

confidence: 99%

“…2013[ 45 ] α Papua New Guinea CT AL (NR) 594 NR NR NR NR NR 99.8% NR 97.8% 88% NR NR NR Mohapatra et al 2013 [ 41 ] NR India CT AS (7) 60 48.2 h 47.8 h NR NR NR NR NR 96.6% NR NR NR NR Barber et al 2013 [ 46 ] NA Malaysian Borneo CT AL + PQ (+AS) 43 48 h 24 h NR NR NR NR NR NR NR NR NR NR Abdallah et al . 2012[ 47 ] α Sudan CT AL + PQ (3 + 14) 38 NR NR 94.7% 100% NR …”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

Visser

Wieten

Kroon

et al. 2014

Malar J

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BackgroundArtemisinin combination therapy (ACT) is recommended as first-line treatment for uncomplicated Plasmodium falciparum malaria, whereas chloroquine is still commonly used for the treatment of non-falciparum species (Plasmodium vivax, Plasmodium ovale and Plasmodium malariae). A more simplified, more uniform treatment approach across all malaria species is worthwhile to be considered both in endemic areas and for malaria as an imported condition alike.MethodsA PROSPERO-registered systematic review to determine the efficacy and safety of ACT for the treatment of non-falciparum malaria was conducted, following PRISMA guidelines. Without language restrictions, Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus were searched for studies published up to November 2014.ResultsThe literature search identified 986 reports; 40 publications were found eligible for inclusion, all of them on non-falciparum malaria in endemic areas. Most evidence was available for P. vivax (n = 35). Five clinical trials in total were identified evaluating ACT for P. ovale, P. malariae and Plasmodium knowlesi. Most ACT presentations have high efficacy against P. vivax parasites; artemisinin-based combinations have shorter parasite and fever clearance times compared to chloroquine. ACT is as effective as chloroquine in preventing recurrent parasitaemia before day 28. Artemisinin-based combinations with long half-lives show significantly fewer recurrent parasitaemia up to day 63. The limited evidence available supports both the use of chloroquine and an ACT for P. ovale and P. malariae. ACT seems to be preferable for optimal treatment of P. knowlesi.ConclusionACT is at least equivalent to chloroquine in effectively treating non-falciparum malaria. These findings may facilitate development of simplified protocols for treating all forms of malaria with ACT, including returning travellers. Obtaining comprehensive efficacy and safety data on ACT use for non-falciparum species particularly for P. ovale, P. malariae and P. knowlesi should be a research priority.Trial registrationCRD42014009103Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-463) contains supplementary material, which is available to authorized users.

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“…Sudan has endemic levels of many communicable diseases, such as malaria [2,3], which necessitate speedy, safe and accurate temperature measurement for screening for fever.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of tympanic temperature measurement using an infrared tympanic membrane thermometer

et al. 2013

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BackgroundDuring investigation and diagnosis of patients, accurate temperature measurement is of great importance. The advantages of tympanic membrane thermometry are speed (temperature reading available within seconds), safety, and ease of use. The aim of this study was to compare the accuracy of infrared tympanic thermometers in comparison to mercury thermometers in measurement of body temperature.MethodsAxillary and tympanic temperature was measured simultaneously in consecutive patients using mercury glass and infrared tympanic thermometers at Omdurman Hospital, Sudan during October 2012.ResultsIn total, temperature was measured in 174 patients, 95 of whom (54.6%) were male. The mean (SD) patient age and weight was 33.18 (25.07) years and 52.13 (69.85) kg. There was no significant difference in mean (SD) temperature measurement between mercury and infrared tympanic membrane thermometers, 37.29°C (0.91) versus 37.38°C (0.95), P = 0.373, respectively. There was a significant positive correlation between axillary and tympanic body temperature measurements (r = 0.697, P < 0.001). The mean difference between the two readings (with limits of agreements) was - 0.093 (−0.20; 0.02) °C.ConclusionIn this study, tympanic membrane thermometry is as reliable and accurate as axillary mercury glass thermometry. Thus, tympanic thermometry can be used in clinical practice, especially in the emergency setting, where ease of use and speed of obtaining the temperature reading are important.

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Efficacy of artemether-lumefantrine as a treatment for uncomplicated Plasmodium vivax malaria in eastern Sudan

Cited by 12 publications

References 24 publications

Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan

Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

Accuracy of tympanic temperature measurement using an infrared tympanic membrane thermometer

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