Therapeutic Efficacy and Effects of Artemether-Lumefantrine and Amodiaquine-Sulfalene-Pyrimethamine on Gametocyte Carriage in Children with Uncomplicated Plasmodium falciparum Malaria in Southwestern Nigeria

Abstract

The treatment efficacy and effects of artemether-lumefantrine (AL) and amodiaquine-sulfalene-pyrimethamine (ASP) on gametocyte carriage were evaluated in 181 children < or = 10 years of age with uncomplicated Plasmodium falciparum malaria randomized to receive either drug combination. All children recovered clinically. Fever clearance times were similar. The rate of P. falciparum reappearance (recrudescence or re-infection) between two and six weeks after the start of therapy was significantly higher in AL-treated children (P = 0.01). Parasite clearance was significantly faster in children treated with AL (mean +/- SD = 1.7 +/- 0.6 days, 95% confidence interval = 1.58 - 1.83, P = 0.0001) but the polymerase chain reaction-corrected cure rate (90 of 91 versus 84 of 90) and the rate of resolution of malaria-related anemia two weeks after treatment began (45 of 50 versus 33 of 46) were higher in children treated with ASP. Gametocyte carriage rates were similar. Both regimens were well tolerated. Artemether-lumefantrine clears parasitemia more rapidly than ASP but both combinations are effective in treatment of uncomplicated P. falciparum malaria in Nigerian children.

Therapeutic Efficacies of Artemisinin-Based Combination Therapies in Nigerian Children with Uncomplicated Falciparum Malaria during Five Years of Adoption as First-Line Treatments

“…Specific study procedures have been described for each trial. [12][13][14][15][16] In addition, one recently controlled completed but unpublished trial has been included in the analysis. This involved comparison of AL and AA in < 5 year olds.…”

“…Response to drug treatment was assessed using World Health Organization (WHO) 1973 and 2003 criteria 4, 5 as previously described. [12][13][14][15][16] Parasite clearance time was defined as time from drug administration until there was no patent parasitemia for at least 48 hours. Fever clearance time was defined as time from drug administration until body temperature fell to or below 37.4°C and remained below this value for at least 48 hours.…”

“…[12][13][14][15] Capillary blood collected before and during follow-up was used to measure packed cell volume (PCV) or hematocrit. Hematocrits were measured using a microhematocrit tube and microcentrifuge (Hawksley, Lancing, United Kingdom).…”

Productivity and Health: Alternative Productivity Estimates Using Physical Activity

“…ACT is the preferred first line treatment for malaria recommended by the World Health Organization, as there has been no resistance to ACT yet reported in Africa, and ACT has been proven to cure falciparum malaria within 7 days with few to no side effects. ACT also provides protective effects between two and four weeks after treatment (White (2005), Sowunmi et al (2007), and Woodring et al (2010)). …”

Some features of primary and recrudescent amodiaquine-resistant Plasmodium falciparum infections in Nigerian children

“…One of the most frequently used partner drugs for ACT in Africa is amodiaquine (AQ), which is more effective than chloroquine (CQ) for both CQ-sensitive and CQresistant infections. AQ is also used as a partner drug for non-artemisinin-based combination therapy (NACT), especially with antifolates (Schellenberg et al 2002, Sowunmi 2002, Gasasira et al 2003, Sowunmi et al 2007c, and is used as monotherapy in some settings.…”