Therapeutic efficacy of Artemether/Lumefantrine (Coartem®) against Plasmodium falciparum in Kersa, South West Ethiopia

Abstract

BackgroundArtemether/Lumefantrine (Coartem®) has been used as a first-line treatment for uncomplicated Plasmodium falciparum infection since 2004 in Ethiopia. In the present study the therapeutic efficacy of artemether/lumefantrine for the treatment of uncomplicated P. falciparum infection at Kersa, Jima zone, South-west Ethiopia, has been assessed.MethodsA 28 day therapeutic efficacy study was conducted between November 2007 and January 2008, in accordance with the 2003 WHO guidelines. Outcomes were classified as early treatment failure (ETF), late clinical failure (LCF), late parasitological failure (LPF) and adequate clinical and parasitological response (ACPR).Results90 patients were enrolled and completed the 28 day follow-up period after treatment with artemether/lumefantrine. Cure rate was very high, 96.3%, with 95% CI of 0.897-0.992 (PCR uncorrected). Age-stratified data showed adequate clinical and parasitological response (ACPR) to be 100% for children under 5 and 97.4% and 87.3% for children aged 5-14, and adults, respectively. There was no early treatment failure (ETF) in all age groups. Fever was significantly cleared on day 3 (P < 0.05) and 98% of parasites where cleared on day 1 and almost all parasites were cleared on day 3. 72.5% of gametocytes were cleared on day 1, the remaining 27.5% of gametocytes were maintained up to day 3 and total clearance was observed on day 7. Hemoglobin concentration showed a slight increase with parasitic clearance (P > 0.05). No major side effect was observed in the study except the occurrence of mouth ulcers in 7% of the patients.ConclusionsThe current study proved the excellent therapeutic efficacy of artemether/lumefantrine in the study area and the value of using it. However, the proper dispensing and absorption of the drug need to be emphasized in order to utilize the drug for a longer period of time. This study recommends further study on the toxicity of the drug with particular emphasis on the development of oral ulcers in children.

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

“…Parasite clearance rate was 93.9% on day 2 and 96.8% on the day 3. This is similar with studies which were conducted in Kersa district 7 and central Ethiopia 10 in which almost all patients were cleared of parasites on the day 3.…”

“…There was no early treatment failure in all age groups. 7 Eight years have passed since artemether/lumefantrine was adopted as first-line therapy in Ethiopia, which coincided with the Federal Ministry of Health's (FMoH's) ambitious plan to provide universal access to prompt malaria diagnosis and treatment -as recently recommended by World Health Organization (WHO). 8 WHO generally recommends that the efficacy of first-and second-line medicines be tested at least once every 24 months at all sites.…”

Efficacy of artemether-lumefantrine in treatment of malaria among under-fives and prevalence of drug resistance markers in Igombe-Mwanza, north-western Tanzania

“…This is similar to what has been found in other places of Tanzania and Sub-Saharan Africa in general where cure rates ranged from 96 to 100 in children [8][9][10][11]28]. The percentage of re-infection in this study was higher compared to the findings in the above studies.…”

Therapeutic efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in North-Eastern Tanzania

“…Insignificant haematological recovery irrespective of parasite clearance in the younger children suggests that other factors, such as geohelminths, may also play a key role in the chronicity of anaemia as reported in other studies [3]. …”

“…Studies conducted elsewhere showed similar findings whereby <1.1% the children had parasite on day three post-treatment [3, 9]. Artemether-lumefantrine achieves fast parasite clearance as a result of fast action of artemisinins.…”