Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal

Abstract

BackgroundThe national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013–2014).MethodsGiemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000–10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance).ResultsA total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level.ConclusionOnly one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.

The durability of long-lasting insecticidal nets distributed to the households between 2009 and 2013 in Nepal

“…The significant decline of confirmed malaria including P. vivax malaria during 2003 to 2012 has coincided with the scale up of free LLIN distribution policy together with the adoption of artesunate-lumefantrine as the first line of treatment for uncomplicated confirmed P. falciparum malaria [3,13]. IRS is gradually replaced by LLIN coverage in malaria-risk districts [9].…”

Micro-stratification of malaria risk in Nepal: implications for malaria control and elimination

“…With the significant reduction of malaria cases in recent years, the malaria control program in Nepal has set up the vision of “a malaria-free Nepal by 2025” and the country is currently in the pre-elimination phase (Table 4) [5, 15]. Malaria risk mapping by micro-stratification up to the VDC level is critical in order to deploy appropriate and tailored malaria control interventions to achieve the targeted goal of elimination.…”

“…Malaria control and elimination strategies are being accelerated in Southeast Asia and the Greater Mekong region and have mainly focused to halt the spread of artemisinin resistance using multiple control measures such as mass drug administration for malaria hotspots, strengthening village malaria workers, and deployment of LLINs with community engagement strategies wherein community members are trained and devolved with the responsibilities in the malaria risk areas which can be enhanced by malaria micro-stratification study [24–32]. Even though a recent study from Nepal has not yet shown the artemisinin resistance against P. falciparum in Nepal, a continuous monitoring for resistance markers was recommended to be critical [15]. In addition, studies from Nepal have shown P. vivax as a dominating species for the last 50 years [5].…”

Nonclinical safety, tolerance and pharmacodynamics evaluation for meplazumab treating chloroquine-resistant Plasmodium falciparum

“…To date, hundreds of millions of malaria cases occur worldwide, most of which are caused by P. falciparum 1 . Chemical drugs have been used for the elimination of P. falciparum , such as artemisinin and its derivatives 2 , 3 , 4 , 5 . As a good antimalarial drug, chloroquine soon lost its therapeutic effect on P. falciparum after the emergence of resistant strains 6 , 7 , 8 .…”