Adherence and efficacy of supervised versus non-supervised treatment with artemether/lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Bangladesh: a randomised controlled trial.
As artemether/lumefantrine is now deployed as the first-line treatment for uncomplicated falciparum malaria in Bangladesh, information on its efficacy and adherence to its use is important. A randomised controlled non-inferiority trial comparing directly observed treatment (DOT) and non-directly observed treatment (NDOT) was conducted in 320 patients with uncomplicated falciparum malaria in Bandarban Hill Tract District, Bangladesh. Both regimens showed similar high levels of PCR-corrected 42-day parasitological and clinical cure rates (99.3% in the NDOT group and 100% in the DOT group; P=0.49). Survival analysis for the time to recurrence of infection showed no difference between treatment groups (log rank, P=0.98). Adherence, as assessed by counting remaining tablets and oral interviews, was 93% in the NDOT group and was confirmed by Day 7 lumefantrine concentrations. Adherence was independent of educational level. Patients with plasma lumefantrine concentrations < 280 ng/ml at Day 7 were at greater risk for re-infection (relative risk 5.62; P=0.027). The efficacy of artemether/lumefantrine for the treatment of uncomplicated falciparum malaria in Bangladesh is high and is similar for DOT and NDOT. Adherence to therapy is high.
Rahman
Md Mushfiqur
MM
Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand. musfiqr2003@yahoo.com
Dondorp
Arjen M
AM
Day
Nicholas P J
NP
Lindegardh
Niklas
N
Imwong
Mallika
M
Faiz
M A
MA
Bangali
A Mannan
AM
Kamal
A T M Mustafa
AT
Karim
Jahirul
J
Kaewkungwal
Jaranit
J
Singhasivanon
Pratap
P
D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000097:blood / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000097:blood / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D023801:Directly Observed Therapy; D004338:Drug Combinations; D004983:Ethanolamines / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D000077549:Artemether; D000078102:Lumefantrine