Efficacy of artemether-lumefantrine, the nationally-recommended artemisinin combination for the treatment of uncomplicated falciparum malaria, in southern Laos

Malaria Journal

Research

Viengxay Vanisaveth¹  Maniphone Khanthavong¹  Bouasy Hongvanthong¹  Samalane Phompida¹  Mallika Imwong²  Tiengkham Pongvongsa³  Odai Chanthongthip⁴  Paul N Newton⁵  Nicholas J White⁶  Mayfong Mayxay⁷ 

[1] Centre of Malariology, Parasitology and Entomology, Vientiane, Lao PDR;Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Savannakhet Provincial Malaria Station, Savannakhet Province, Lao PDR;Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR;Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR;Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK;Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR;Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK;Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR;Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR;Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK;

关键词: Clinical trial;    Plasmodium falciparum;    Malaria;    Artemisinin-based combination therapy (ACT);    Artemether-lumefantrine;    Coartem;    Laos;   

DOI  :  10.1186/1475-2875-11-184

 received in 2012-04-06, accepted in 2012-05-24,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe Lao Government changed the national policy for uncomplicated Plasmodium falciparum malaria from chloroquine to artemether-lumefantrine (AL) in 2005. Since then, no information on AL efficacy has been reported. With evidence of resistance to artemisinin derivatives in adjacent Cambodia, there has been a concern as to AL efficacy. Monitoring of AL efficacy would help the Lao Government to make decisions on appropriate malaria treatment.MethodsThe efficacy of a three-day, twice daily oral artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in Xepon District, Savannakhet Province, southern Laos was studied over 42 days follow-up. This was part of a trial of thiamin supplementation in falciparum malaria.ResultsOf 630 patients with P. falciparum enrolled in the trial of thiamin treatment, 549 (87%, 357 children ≤15 years and 192 adults) were included in this study. The per protocol 42-day cure rates were 97% (524/541) [96% (337/352) for children and 99% (187/189) for adults, p = 0.042]. By conventional intention-to-treat analysis, the 42-day cure rates adjusted for re-infection, were 97% (532/549) [96% (342/357) in children and 99% (190/192) in adults, p = 0.042]. The proportion of patients who remained parasitaemic at day 1 after treatment was significantly higher in children [33% (116/356)] compared to adults [15% (28/192)] (p < 0.001) and only one adult patient had detectable parasitaemia on day 2. There were no serious adverse events. Potential side effects after treatment were reported more commonly in adults (32%) compared to children (15%) (p < 0.001). Patients with recrudescent infections were significantly younger, had longer mean time to fever clearance, and had longer median time to parasite clearance compared to those who were cured.ConclusionsThe current nationally-recommended anti-malarial treatment (artemether-lumefantrine) remains highly efficacious for the treatment of uncomplicated falciparum malaria five years after introduction in Laos. Regular monitoring is required in case artemisinin-resistant P. falciparum parasites should appear.Trial registrationISRCTN85411059.

【 授权许可】

CC BY   
© Mayxay et al.; licensee BioMed Central Ltd. 2012