Efficacy of Arthemether – Lumenfantrine against Uncomplicated Plasmodium falciparum Malaria in Infants and Children in Uyo, Nigeria

摘要

Coartem is recently approved artemisinin- based tablet that provides effective antimalarial treatment for children in many sub-saharan countries. This study evaluates the efficacy of this drug in 120 children weighing 5-25kg with uncomplicated falciparum malaria in Uyo. Six doses of coartem were given over 3 days with follow up at 7, 14 and 28 days. Treatment rapidly cleared parasitaemia and fever. The overall 28-day cure was 80.1%. Cure rate at 7 and 14 days exceeded 90%. No severe adverse side-effects, clinical failures or parasitological failures were observed among these patient. Coartem therefore appear efficacious for the treatment of uncomplicated malaria in Nigeria. Introduction Malaria is one of the most serious diseases in the tropics claiming millions of lives yearly. Malaria in Africa mainly due to a blood parasite, Plasmodium falciparum. Children under the age of five years and pregnant women are the most afflicted with this debilitating disease. The problem of malaria is compounded by the declining sensitivity of P. falciparum to the array of available antimalarial drugs1. Resistance to antimalarial is responsible for an increase in morbidity and mortality in many sub-saharan countries2. In Nigeria malaria is identified as the most prevalent type of infective and parasitic disease3. Estimates show that this parasitic disease accounts for no less than 300,000 deaths from more than 20 million clinical attacks while 10-20% of hospital admissions are due to malaria. The problem of malaria in Nigeria is complicated by the emergence of drug resistant malaria parasites. As a response to increasing levels of resistance to antimalarials drug, World Health Organisation recommends that all countries experiencing resistance to conventional monotherapies such as chloroquine, amodiaquine or sulfadoxine – Pyrimethamine (SP) should use combination therapies preferably those containing artemisnin derivatives (ACTs – artemisinin based combination therapies) for falciparum malaria4.Artemether – Lumefantrine also known under the brand name coartemR is a new artemisinin – containing fixed combination antimalarial treatment that has proved to be well tolerated and highly effective against Plamodium falciparum 5. The goal of chemotherapy in malaria is often to effect a clinical cure or parasitological clearance or to limit the development of drug resistance6. Accurate and effective surveillance systems for monitoring antimalarial drug efficacy have been recognized as an essential basis for decisions on the use of drug. The main purpose of this study was to ascertain the therapeutic efficacy of coartem in the treatment of uncomplicated P. falciparum malaria in Uyo, South Eastern Nigeria. The data obtained from this study would provide useful information for future management of uncomplicated falciparum malaria in Nigeria. Material And Methods Study SiteThe study was carried out between July and December, 2007 in Uyo, Southern Nigeria. Uyo is located on latitude 5003' North and longitude 7057' East. It is the capital city of Akwa Ibom State Nigeria. Akwa Ibom State is located within the lowland coastal plain region of Nigeria between latitude 4032' and 5053' North and longitude 7025' and 8025' East. The state lies on the Eastern Niger Delta and shares the hot humid tropical climate of the region marked by two distinct seasons – dry (November to March) and wet (April to October) seasons. As in the entire country malaria is endemic and the transmission is intense (stable) and peaks during the rainy season. PatientsThis study followed the World Health Organisation7 recommendation, for the in-vivo investigations of antimalarial drug efficacy, in terms of treatment, follow up and data analysis. The study was conducted in children with fever weighing 5-25kg, who were attending Nedeke Paediatrics Specialist Hospital, Uyo, using the WHO 28 day in-vivo protocol, patients, were enrolled in the study, if they satisfied the following inclusion crite