Safety and therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated <i>Plasmodium falciparum</i> malaria at Shecha health centre, Arba Minch, Ethiopia

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Abstract

Background

In 2004, Ethiopia adopted artemether-lumefantrine (AL, Coartem ^®) as first-line treatment for the management of uncomplicated Plasmodium falciparum malaria. Continuous monitoring of AL therapeutic efficacy is crucial in Ethiopia, as per the World Health Organization (WHO) recommendation. This study aimed to assess the therapeutic efficacy of AL in the treatment of uncomplicated P. falciparum infection.

Methods

A 28 day onearm, prospective evaluation of the clinical and parasitological response to AL was conducted at Shecha Health Centre, Arba Minch town, Southern Ethiopia. Patients were treated with six-dose regimen of AL over three days and monitored for 28 days with clinical and laboratory assessments. Participant recruitment and outcome classification was done in accordance with the 2009 WHO methods for surveillance of anti-malarial drug efficacy guidelines.

Results

A total of 88 study participants were enrolled and 69 of them completed the study with adequate clinical and parasitological response. Two late parasitological failures were observed, of which one was classified as a recrudescence by polymerase chain reaction (PCR). The PCRcorrected cure rate was 98.6% (95% CI 92.3–100). AL demonstrated a rapid parasite and fever clearance with no parasitaemia on day 2 and febrile cases on day 3. Gametocyte clearance was complete by day three. No serious adverse events were reported during the 28 days follow-up.

Conclusion

The study demonstrated high therapeutic efficacy and good safety profile of AL. This suggests the continuation of AL as the first-line drug for the treatment of uncomplicated P. falciparum malaria in Ethiopia. Periodic therapeutic efficacy studies and monitoring of markers of resistance are recommended for early detection of resistant parasites.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04436-8.

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Most cited references 48

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Qinghaosu (artemisinin): the price of success.

N. White (2008)

Artemisinin and its derivatives have become essential components of antimalarial treatment. These plant-derived peroxides are unique among antimalarial drugs in killing the young intraerythrocytic malaria parasites, thereby preventing their development to more pathological mature stages. This results in rapid clinical and parasitological responses to treatment and life-saving benefit in severe malaria. Artemisinin combination treatments (ACTs) are now first-line drugs for uncomplicated falciparum malaria, but access to ACTs is still limited in most malaria-endemic countries. Improved agricultural practices, selection of high-yielding hybrids, microbial production, and the development of synthetic peroxides will lower prices. A global subsidy would make these drugs more affordable and available. ACTs are central to current malaria elimination initiatives, but there are concerns that tolerance to artemisinins may be emerging in Cambodia.

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Evidence of Artemisinin-Resistant Malaria in Africa

Betty Balikagala, Naoyuki Fukuda, Mie Ikeda … (2021)

In the six Southeast Asian countries that make up the Greater Mekong Subregion, Plasmodium falciparum has developed resistance to derivatives of artemisinin, the main component of first-line treatments for malaria. Clinical resistance to artemisinin monotherapy in other global regions, including Africa, would be problematic.

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Acquired immunity to malaria.

Denise Doolan, Carlota Dobaño, J. Baird (2009)

Naturally acquired immunity to falciparum malaria protects millions of people routinely exposed to Plasmodium falciparum infection from severe disease and death. There is no clear concept about how this protection works. There is no general agreement about the rate of onset of acquired immunity or what constitutes the key determinants of protection; much less is there a consensus regarding the mechanism(s) of protection. This review summarizes what is understood about naturally acquired and experimentally induced immunity against malaria with the help of evolving insights provided by biotechnology and places these insights in the context of historical, clinical, and epidemiological observations. We advocate that naturally acquired immunity should be appreciated as being virtually 100% effective against severe disease and death among heavily exposed adults. Even the immunity that occurs in exposed infants may exceed 90% effectiveness. The induction of an adult-like immune status among high-risk infants in sub-Saharan Africa would greatly diminish disease and death caused by P. falciparum. The mechanism of naturally acquired immunity that occurs among adults living in areas of hyper- to holoendemicity should be understood with a view toward duplicating such protection in infants and young children in areas of endemicity.

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Author and article information

Contributors

Solomon Mequanente Abay: Solomon.mequanente@aau.edu.et

Journal

Journal ID (nlm-ta): Malar J

Journal ID (iso-abbrev): Malar J

Title: Malaria Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2875

Publication date (Electronic): 7 January 2023

Publication date PMC-release: 7 January 2023

Publication date Collection: 2023

Volume: 22

Electronic Location Identifier: 9

Affiliations

[1 ]GRID grid.449044.9, ISNI 0000 0004 0480 6730, Department of Pharmacy, College of Health Sciences, , Debre Markos University, ; Debre Markos, Ethiopia

[2 ]GRID grid.7123.7, ISNI 0000 0001 1250 5688, Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, , Addis Ababa University, ; Addis Ababa, Ethiopia

[3 ]GRID grid.452387.f, ISNI 0000 0001 0508 7211, Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, , Ethiopian Public Health Institute, ; Addis Ababa, Ethiopia

[4 ]GRID grid.414835.f, ISNI 0000 0004 0439 6364, Ethiopian Ministry of Health, ; Addis Ababa, Ethiopia

[5 ]World Health Organization, Addis Ababa, Ethiopia

[6 ]GRID grid.10698.36, ISNI 0000000122483208, Institute of Infectious Disease and Global Health, , University of North Carolina at Chapel Hill, ; Chapel Hill, USA

Article

Publisher ID: 4436

DOI: 10.1186/s12936-022-04436-8

PMC ID: 9824982

PubMed ID: 36611179

SO-VID: f692eece-486a-4682-a566-2a78dc384b57

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 October 2022

Date accepted : 29 December 2022

Funding

Funded by: Ethiopian Public Health Institute

Funded by: FundRef http://dx.doi.org/10.13039/501100007941, Addis Ababa University;

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: therapeutic efficacy,artemether-lumefantrine,uncomplicated malaria,ethiopia

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: therapeutic efficacy, artemether-lumefantrine, uncomplicated malaria, ethiopia

Safety and therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria at Shecha health centre, Arba Minch, Ethiopia

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Abstract

Background

Methods

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Conclusion

Supplementary Information

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Coronaviruses, COVID-19 and SARS-CoV-2

Most cited references 48

Qinghaosu (artemisinin): the price of success.

Evidence of Artemisinin-Resistant Malaria in Africa

Acquired immunity to malaria.

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