title: Comparison of artemether-lumefantrine with sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in eastern Nepal.
abstract: Because available data suggest that resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) is increasing in Nepal, an open-label, parallel-group efficacy/safety study was conducted in 99 Nepalese patients with uncomplicated falciparum malaria randomized 2:1 to artemetherlumefantrine (AL) or SP. Efficacy was assessed from clinical and microscopic evidence of treatment failure. Four SP-treated patients (12.1%; 95% CI, 4.0-29.1%) redeveloped parasitemia during the 28-day follow-up versus 0% (95% CI, 0-6.9%) in the AL group (P = 0.011), a difference that was confirmed by polymerase chain reaction (PCR) analysis of parasite DNA. PCR detected an additional six patients (two SP and four AL) with sub-microscopic gametocytemia or breakthrough parasitemia between Days 14 and 28, suggesting that AL efficacy was lower than estimated by microscopy. Dhfr and dhps mutations were not associated with outcome. AL is more effective than SP for uncomplicated malaria in Nepal, but regular monitoring of its efficacy should be carried out if this combination therapy is introduced.
authors.affiliation: Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal.
authors.forename: Suman
authors.initials: S
authors.lastname: Thapa
authors.forename: Judith
authors.initials: J
authors.lastname: Hollander
authors.forename: Mary
authors.initials: M
authors.lastname: Linehan
authors.forename: Janet
authors.initials: J
authors.lastname: Cox-Singh
authors.forename: Mahendra B
authors.initials: MB
authors.lastname: Bista
authors.forename: Garib D
authors.initials: GD
authors.lastname: Thakur
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D004338:Drug Combinations; D004351:Drug Resistance; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D016780:Malaria, Vivax / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009390:Nepal; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics; D010966:Plasmodium vivax / Q000302:isolation & purification; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome