Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal
Open Access
- 14 August 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in Tropical Diseases, Travel Medicine and Vaccines
- Vol. 4 (1), 9
- https://doi.org/10.1186/s40794-018-0068-2
Abstract
BackgroundThe national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013-2014).MethodsGiemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000-10,000 /mu L of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance).ResultsA total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level.ConclusionOnly one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.Keywords
Funding Information
- World Health Organization, country office
This publication has 36 references indexed in Scilit:
- Therapeutic efficacy of Artemether/Lumefantrine (Coartem®) against Plasmodium falciparum in Kersa, South West EthiopiaParasites & Vectors, 2010
- A Randomized Trial of Artesunate Mefloquine versus Artemether Lumefantrine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Senegalese ChildrenThe American Journal of Tropical Medicine and Hygiene, 2010
- Therapeutic efficacy of artemether-lumefantrine in uncomplicated falciparum malaria in IndiaMalaria Journal, 2009
- Failure of artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria in southern CambodiaMalaria Journal, 2009
- Molecular genotyping to distinguish between recrudescents and new infections in treatment trials of Plasmodium falciparum malaria conducted in Sub-Saharan Africa: adjustment of parasitological outcomes and assessment of genotyping effectivenessTropical Medicine & International Health, 2006
- Artemisinin-based combination therapies (ACTs): Best hope for malaria treatment but inaccessible to the needy!Acta Tropica, 2005
- Therapeutic efficacy of antimalarial drugs along the eastern Indo-Nepal border: a cross-border collaborative studyTransactions of the Royal Society of Tropical Medicine and Hygiene, 2005
- Therapeutic efficacy of artemether-lumefantrine and artesunate-mefloquine for treatment of uncomplicated Plasmodium falciparum malaria in Luang Namtha Province, Lao People's Democratic RepublicTropical Medicine & International Health, 2004
- Severe falciparum malariaTransactions of the Royal Society of Tropical Medicine and Hygiene, 2000
- The Clock of the Malaria ParasiteScientific American, 1970