Efficacy of artemether–lumefantrine for the treatment of uncomplicated falciparum malaria in northwest Cambodia

Abstract

Summaryobjective To determine the efficacy of artemether-lumefantrine malaria treatment, as an alternative to artesunate + mefloquine, which is becoming ineffective in some areas of the Thai-Cambodian border. With the per-protocol analysis, the cure rate was 71.1% in study AL2002, 86.5% in study AL2003 and 92.4% in study AM2003. All the data were PCR corrected. The artemether-lumefantrine cure rate was unexpectedly low in 2002, but it increased with food supplementation in 2003. There was a significant difference (P ¼ 0.02) in lumefantrine plasma concentrations between adequate clinical and parasitological responses and treatment failure cases. In vitro susceptibility to lumefantrine was reduced for isolates sampled from patients presenting with treatment failure, but the difference was not statistically different from isolates sampled from patients who were successfully treated.conclusion Treatment failure cases of artemether-lumefantrine are most probably because of low levels of lumefantrine blood concentration. Further investigations are necessary to determine whether resistance of Plasmodium falciparum isolates to lumefantrine is present in the region.

Treatment with Coartem (Artemether-Lumefantrine) in Papua New Guinea

“…28 An increase in treatment success by 15% was observed in a study in Thailand when a fatty diet was coadministered with Coartem. 29 In this study, parents or guardians of the study participants were advised to administer treatment with a fatty diet, however, no information is available to what extent these recommendations were followed. Inadequate plasma concentrations of lumefantrine might therefore have contributed to the high rate of treatment failures.…”

Artemether-Lumefantrine Compared to Atovaquone-Proguanil as a Treatment for Uncomplicated Plasmodium falciparum Malaria in Travelers

“…9,10,20 To date, very few treatment failures had been documented with AL. [13][14][15] Some reported AL failures may have been due, as in our case, to incomplete drug administration rather than to parasite resistance. 13,15 Our study also showed that the fever clearance time was 44 ± 22.7 hours in patients treated with AL.…”

“…[13][14][15] Some reported AL failures may have been due, as in our case, to incomplete drug administration rather than to parasite resistance. 13,15 Our study also showed that the fever clearance time was 44 ± 22.7 hours in patients treated with AL. Although somewhat longer than that reported in previous AL studies, 16,18 it was shorter by 33 hours (a 57% reduction) than the fever clearance time on AP, which was 77 ± 28.0 hours (similar to that seen in other AP studies).…”

“…To date, few treatment failures have been reported. [13][14][15] A recent study evaluated the tolerability and efficacy of a standard 6 doses course of AL in non-immune patients and found a 96% cure rate. 16 The relative efficacy of AP and AL has not been evaluated in head-to-head clinical trials.…”

Mitigating the threat of artemisinin resistance in Africa: improvement of drug-resistance surveillance and response systems

“…36 Furthermore, the relation between resistant genotypes and most drug-resistant parasite phenotypes and clinical outcomes is not always straightforward. 37,38 Another difficulty is that the results from in-vitro assays after the use of ex-vivo techniques, such as SYBR-green-based protocols or isotope incorporation assays, are very difficult to compare between different sites because of differences in methods.…”