title: Artemether-lumefantrine and liver enzyme abnormalities in non-severe Plasmodium falciparum malaria in returned travellers: a retrospective comparative study with quinine-doxycycline in a Portuguese centre.
abstract: Artemisinin-based therapy is the current standard treatment for non-severe malaria due to Plasmodium falciparum. The potential for asymptomatic liver toxicity of this therapy and its implication in clinical practice is currently unknown. The aim of this study is to assess the hepatic function in patients treated with a standard three-day artemisinin-based regimen and to compare it with the quinine-doxycycline regimen.
  
  
  
  Retrospective and comparative study of returned adult travellers admitted with non-severe P. falciparum malaria. Fifty-seven patients were included: 19 treated with artemisinin-based therapy and 38 with quinine-doxycycline therapy.
  
  
  
  During treatment, when compared with quinine-doxycycline group, the artemisinin-lumefantrine group presented a higher proportion of significant liver enzyme abnormalities (42 vs. 5%, p < 0.01) and a higher peak value of aspartate aminotransferase (131 vs. 64 U/L, p < 0.01) and alanine aminotransferase (99 vs. 75 U/L, p = 0.05). None of the patients was symptomatic, there were no treatment interruptions and all patients achieved clinical cure.
  
  
  
  Treatment of uncomplicated falciparum malaria with artemisinin-based therapy might cause asymptomatic liver enzyme abnormalities in the first days of treatment. Nevertheless, these liver enzyme abnormalities seem to be harmless, asymptomatic and self-limited.
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal. pintoandre@gmail.com.
authors.forename: André
authors.identifier: 0000-0002-2077-3356
authors.initials: A
authors.lastname: Silva-Pinto
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal.
authors.forename: Rogério
authors.initials: R
authors.lastname: Ruas
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Almeida
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Duro
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Silva
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal.
authors.forename: Cândida
authors.initials: C
authors.lastname: Abreu
authors.affiliation: Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, 4200, Porto, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D015331:Cohort Studies; D004318:Doxycycline / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011803:Quinine / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011803:Quinine; D004318:Doxycycline
keywords: Artemether–lumefantrine; Liver dysfunction; Malaria; Plasmodium falciparum