Therapeutic efficacy of artemetherlumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Ethiopia:a systematic review and meta-analysis

摘要

Background:As Ethiopia is one of the sub-Saharan countries with a great burden of malaria the effectiveness of first line anti-malarial drugs is the major concern.The aim of this study was to synthesize the available evidence on the efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Ethiopia.This was done by performing a meta-analysis of recent studies conducted in the country on this topic.Methods:Studies published between January 2010 and January 2017 that reported on the efficacy of artemetherlumefantrine in the treatment of P.falciparum malaria in Ethiopian patients were searched for using the PubMed and Google Scholar databases.Ten prospective single-arm cohort studies that followed patients for 28-42 days were included in this analysis.All of the included studies were deemed to be of high quality.Results:Ten studies involving 1179 patients that were eligible for meta-analysis were identified.At recruitment,the average parasite count per patient was 12981/μl of blood.On the third day of treatment,96.7%and 98.5%of the study subjects become fever-free and parasite-free,respectively.Based on the per protocol analysis,the cure rate after use of artemether-lumefantrine was 98.2%(polymerase chain reaction corrected)and 97.01%(polymerase chain reaction uncorrected)after 28 days of follow-up.The reinfection rate within 28 days was 1.1%and the recrudescence rate was 1.9%.Conclusions:This review found that the cure rate for uncomplicated P.falciparum malaria using artemetherlumefantrine in Ethiopia is still high enough to recommend the drug as a first-line agent.There should be careful periodic monitoring of the efficacy of this drug,as treatment failure may occur due to resistance,sub-therapeutic levels that may occur due to non-adherence,or inadequate absorption.