Impact of using artemisinin-based combination therapy (ACT) in the treatment of uncomplicated malaria from Plasmodium falciparum in a non-endemic zone

Abstract

BackgroundArtemisinin-based combination therapy (ACT) has been adopted by the World Health Organization as a first-line treatment for uncomplicated Plasmodium falciparum malaria. In endemic regions, it has proven more effective in treating the disease, and even in reducing its transmission. Nonetheless, there is a scarcity of studies carried out in non-endemic areas on imported uncomplicated malaria.MethodsThis is a retrospective, observational study performed on patients diagnosed and admitted with uncomplicated P. falciparum malaria between 2004 and 2015. The objective was to compare the parasite clearance period and the average hospital length of stay for patients treated with ACT vs those receiving other treatment regimens.ResultsEighty-five patients were included in the study. Fifty-one received ACT treatment (dihydroartemisinin–piperaquine) and thirty-four patients were treated with quinine sulfate+doxycycline or atovaquone/proguanil. The parasite clearance period was shorter in the group of patients treated with ACT compared to those receiving other treatment types: 24 h (IQR 24) vs 48 h (IQR 48), p < 0.01. The average hospital stay was also shorter in the ACT group with respect to the second group: 2.67 days (IQR 1.08) vs 3.96 days (IQR 2.87), p < 0.001. A mild case of hepatitis was registered in the group treated with ACT.ConclusionsACT treatment of admitted hospital patients with imported uncomplicated malaria from P. falciparum reduced the days spent hospitalized as well as producing a more rapid parasite clearance compared to classic treatment. In spite of being treated with safe medications, one has to be alert to possible adverse effects such as hepatitis and delayed haemolytic anaemia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1408-1) contains supplementary material, which is available to authorized users.

Safety, Pharmacokinetics, and Mosquito‐Lethal Effects of Ivermectin in Combination With Dihydroartemisinin‐Piperaquine and Primaquine in Healthy Adult Thai Subjects

“…It is unclear whether those elevations were related to malaria or to its treatment. One case of mild hepatitis was linked to dihydroartemisinin‐piperaquine in a P. falciparum ‐infected patient . There are some reports of hepatotoxicity associated with ivermectin.…”

Antimalarial Properties of Aqueous Crude Extracts ofGynostemma pentaphyllumandMoringa oleiferaLeaves in Combination with Artesunate inPlasmodium berghei-Infected Mice

“…The significant decrease in parasitemia levels in response to combination treatment compared to the control, observed with the mice, was the main finding in this study. Hence, the addictive effect of these extracts with artesunate is important in the context that offers opportunities to further standardize new artemisinin-based combination therapy as possible antimalarial combination [46]. …”

In Vitro Antimalarial and Cytotoxic Activities of Sauropus androgynus Leaves Extracts

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