Therapeutic efficacy of artemether-lumefantrine for Plasmodium vivax infections in a prospective study in Guyana.
BACKGROUND
In Guyana, chloroquine + primaquine is used for the treatment of vivax malaria. A worldwide increase of chloroquine resistance in Plasmodium vivax led to questioning of the current malaria treatment guidelines. A therapeutic efficacy study was conducted using artemether-lumefantrine + primaquine against P. vivax to evaluate a treatment alternative for chloroquine.


METHODS
From 2009 to 2010, a non-controlled study in two hospitals in Guyana was conducted. A total 61 patients with P. vivax infection were treated with artemether-lumefantrine as a six-dose regimen twice a day for three days with additional 0.25 mg/kg/d primaquine at day 0 for 14 days. Clinical and parasitological parameters were followed on days 0,1,2,3,7,14 and 28 in agreement with WHO guidelines. Plasmodium vivax DNA from eight patients was analysed for pvmdr1, molecular marker of resistance.


RESULTS
Artemether-lumefantrine cleared 100% of parasites on day 1, but two patients (3%) had recurrence of parasites on day 28, suggesting relapse. No pvmdr1 Y976F polymorphism was detected. The treatment regimen was well tolerated.


CONCLUSIONS
In Guyana, artemether-lumefantrine represents an adequate treatment option against P. vivax when combined with primaquine. Availability of this alternative will be of great importance in case of emerging chloroquine resistance against P. vivax.
Malaria Research Unit, CNRS UMR 5246, University Lyon 1, Faculty of Medicine, Lyon, France. daniel.eibach@chu-lyon.fr
Daniel
D
Eibach
Nicolas
N
Ceron
Karanchand
K
Krishnalall
Keith
K
Carter
Guillaume
G
Bonnot
Anne-Lise
AL
Bienvenu
Stéphane
S
Picot
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000235:genetics; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage*; D006172:Guyana; D006801:Humans; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000469:parasitology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000235:genetics; D020125:Mutation, Missense; D010966:Plasmodium vivax / Q000302:isolation & purification; D011319:Primaquine / Q000008:administration & dosage; D011446:Prospective Studies; D015800:Protozoan Proteins / Q000235:genetics; D016896:Treatment Outcome; D055815:Young Adult
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D016054:DNA, Protozoan; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D027425:ATP-Binding Cassette, Sub-Family C Proteins; D011319:Primaquine; D015800:Protozoan Proteins; C541684:Mdr1 protein, Plasmodium vivax