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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Efficacy of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in northwest Cambodia
Tropical Medicine and International Health, Volume 11, No. 12, Year 2006
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Description
Objective: To determine the efficacy of artemether-lumefantrine malaria treatment, as an alternative to artesunate + mefloquine, which is becoming ineffective in some areas of the Thai-Cambodian border. Methods: Two studies were conducted to monitor the efficacy of artemether-lumefantrine in Sampov Lun referral hospital, Battambang Province, in 2002 and 2003, and one study was conducted to assess the efficacy of mefloquine + artesunate in 2003 for comparison. The studies were performed according to the WHO standardized protocol with a follow-up of 28 days. The therapeutic efficacy tests were complemented with in vitro tests and in 2003, with the measurement of lumefantrine plasma concentration at day 7 for the patients treated with artemether-lumefantrine. Results: A total of 190 patients were included: 55 were treated with artemether-lumefantrine in 2002 (AL2002), 80 with artemether-lumefantrine and food supplementation in 2003 (AL2003) and 55 with artesunate + mefloquine in 2003 (AM2003). With the per-protocol analysis, the cure rate was 71.1% in study AL2002, 86.5% in study AL2003 and 92.4% in study AM2003. All the data were PCR corrected. The artemether-lumefantrine cure rate was unexpectedly low in 2002, but it increased with food supplementation in 2003. There was a significant difference (P = 0.02) in lumefantrine plasma concentrations between adequate clinical and parasitological responses and treatment failure cases. In vitro susceptibility to lumefantrine was reduced for isolates sampled from patients presenting with treatment failure, but the difference was not statistically different from isolates sampled from patients who were successfully treated. Conclusion: Treatment failure cases of artemether-lumefantrine are most probably because of low levels of lumefantrine blood concentration. Further investigations are necessary to determine whether resistance of Plasmodium falciparum isolates to lumefantrine is present in the region. © 2006 Blackwell Publishing Ltd.
Authors & Co-Authors
Denis, Mey Bouth
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Switzerland, Geneva
Organisation Mondiale de la Santé
Tsuyuoka, Reiko
Switzerland, Geneva
Organisation Mondiale de la Santé
Lim, Pharath
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Lindegårdh, Niklas
Thailand, Nakhon Pathom
Mahidol University
United Kingdom, Oxford
Churchill Hospital
Yi, Poravuth
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Socheat, Duong
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Fandeur, Thierry
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Annerberg, Anna
Thailand, Nakhon Pathom
Mahidol University
Christophel, Eva Maria
Switzerland, Geneva
Organisation Mondiale de la Santé
Ringwald, Pascal
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Citations: 135
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1111/j.1365-3156.2006.01739.x
ISSN:
13653156
Research Areas
Food Security
Health System And Policy
Infectious Diseases
Study Design
Cohort Study