Therapeutic efficacy of artemether–lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Enfranze, north-west Ethiopia

Abstract

BackgroundPlasmodium falciparum accounts for approximately 60% of malaria cases in Ethiopia and artemether–lumefantrine has been used as a first-line treatment for uncomplicated P. falciparum malaria since 2004. The aim of this study was to assess the therapeutic efficacy of artemether–lumefantrine (AL) for the treatment of uncomplicated P. falciparum malaria in north-western Ethiopia.MethodsA 28-day one-arm, prospective evaluation of the clinical and parasitological response to the first-line treatment for uncomplicated P. falciparum malaria was conducted in Enfranze Health Centre in accordance with the 2009 WHO efficacy study guidelines. Patients were treated with a 3-day course of AL and clinical and parasitological parameters were monitored over a 28-day follow-up. All data from recruited patients were imported into an electronic data base and Kaplan–Meier survival analysis was used for analysing primary [early treatment failures (ETF), late clinical failure (LCF), late parasitological failures (LPF), and adequate clinical and parasitological response (ACPR)] and secondary (PCT, GCT and FCT) outcomes.ResultsEighty patients were enrolled and all of them completed the 28-day follow-up period. The PCR-corrected cure rate was 95.0% (95% CI 87.0–98.4%) and there were two ETF, one LCF and three LPF. Two of the LPF were classified as re infections by PCR. Seventy three point seven five percent, 91.25 and 95% of patients had cleared their parasitaemia by days 1, 2, and 3, respectively, and 75, 91.25 and 96.25% of patients had cleared their fever by days 1, 2, and 3. All patients completely cleared their gametocytes by day 7.ConclusionThe relatively high cure rate, low proportion of patients still positive on day 3 as well as parasite clearance times in this study would indicate no imminent threat of artemisinin resistance development in the region. However, the threat of spreading or de novo development of artemisinin resistance warrants regular monitoring of drug efficacy throughout the region.

Therapeutic efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in a high-transmission area in northwest Ethiopia

“…This result is consistent with other studies in Ethiopia and elsewhere [55, 59, 61]. Two separate studies conducted in Ethiopia showed higher gametocyte clearance rate (all cleared at D7) [23, 60] although in another study conducted in Southern Ethiopia gametocytes persisted up to D28 [35]. …”

West Africa International Centers of Excellence for Malaria Research: Drug Resistance Patterns to Artemether–Lumefantrine in Senegal, Mali, and The Gambia

“…A similar profile was observed in Mali. This parasite clearance time obtained in Mali and the Gambia is considered to be below the threshold indicating potentially emerging resistance and is comparable to previous findings from Ethiopia 43 and Burkina Faso 39 and is considerably lower than the 21.9% parasitemic patients on day 3 reported from a trial conducted in western Cambodia as early as 2007. 33 In Senegal, parasite clearance was obtained by day 3, except in 2011, where parasites were cleared by day 1.…”

Antimalarial Treatment Outcomes In Ethiopia: A Systematic Review And Meta-Analysis

“…An updated search of available literature identified 231 titles, of which two RCTs) [18,19], 15 one-arm in vivo drug efficacy studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], and four prospective observational studies [35][36][37][38] were deemed eligible included in this analysis came from individual treatment programmes across Ethiopia and reported treatment outcomes for a range of 69 [35] to 487 patients [26]. One unpublished Master's thesis dissertation [36] was included and the rest were published in scientific journals [18-35, 37, 38].…”

“…Seventeen interventional studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] were assessed using the modified Jadad scale [14] while the remaining four studies [35][36][37][38] were assessed with the STROBE statement [15]. Eleven interventional and two observational studies were judged to have high quality (Additional file 3).…”