Efficacy of artemether-lumefantrine and artesunate-amodiaquine for treating uncomplicated falciparum malaria in children
Abstract
Background Artesunate-amodiaquine (ASAQ) has been used
as a firsdine treatment for uncomplicated faldparum malaria
in Indonesia since 2004. Its efficacy depends on amodiaquine
resistance of the infecting parasites. Artemether-lumefantrine
(AL) has been shown to be highly efficacious in treating
uncomplicated faldparum malaria in several countries. However,
there have been few studies on these anti-malarial medications
in Indonesia.
Objective To compare the efficacy of AL to ASAQ for treating
uncomplicated faldparum malaria in children.
Methods An open, randomized, controlled trial was
conducted in school-aged children in the Mandailing Natal
Regency, North Sumatera Province, Indonesia, from October
to December 2010. A total of 280 pediatric, uncomplicated
falciparum malaria patients were randomly assigned to receive
either AL or ASAQ for 3 days. Participants were followed-up on
days 1,2,3,7, 14, 28 and 42 following the first medication dose.
The outcomes noted were adequate clinical and parasitological
response (ACPR), parasite reduction, parasite clearance time,
fever clearance time and adverse events. Analysis was based
on intention-to-treat.
Results In this study, ACPRs on day 42 were 86.4% and 90.7%
for the ASAQ and AL groups, respectively (p=0.260). On days 7
and 14, the AL group had higher cure rates than that of the ASAQ
group (P<0.05). Early treatment failure, late treatment failure and
parasitological failure for both groups were similar. We also found
faster parasite clearance time and higher parasite reduction in the
AL group than in the ASAQ group. However, fever clearance
time was shorter in the ASAQ group. The incidence of adverse
events such as nausea, vomiting, malaise, and pruritus were similar
between the two groups (P=0.441).
Conclusion AL had higher efficacy than ASAQ for the treatment of uncomplicated falciparum malaria in children.
[Paediatr rndones. 2012;52:260-6].
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Accepted 2016-09-07
Published 2012-10-31
