Efficacy of artemether-lumefanthrine combination in rural Nigeria

Context/Objective: Irrational and inadequate drug use is common among rural natives of developing countries and this trend threatens the therapeutic life spans of currently recommended artemisinin combination drugs. This study tested the efficacy of artemether-lumefanthrine in children in rural dwellings of Nigeria. Method: The 14-day 2003 WHO antimalarial efficacy protocol was used. Eighty children were recruited and a six-dose treatment of the drug administered. Non-PCR adjusted cure rates and treatment failures were the measured outcomes. Results: Seventy six children completed the study as stipulated by the WHO protocol. Nearly all the children recovered clinically. About 94% (71/76) had similar fever clearance time of 3 days, with only one patient having mild fever on the 14th day. Early treatment failure was seen in four patients, late clinical failure was observed in one patient, but no report of late parasitogical failure was recorded. A non-PCR adjusted adequate clinical and parasitological response was therefore seen in 93% (71/76) of patients. The mean fever and parasitemia clearance was 48.5±25.2 and 39.3±20.1 respectively. Conclusion: Artemether-Lumefanthrine combination is still an effective antimalarial option in rural Nigeria; however the absence of an absolute efficacy may be a sign of a failing efficacy profile.