Artemether–Lumefantrine Efficacy for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Choco, Colombia after 8 Years as First-Line Treatment
Autor: | Alexandre Macedo de Oliveira, Mario Javier Olivera, Ángela Patricia Guerra, Julio Padilla, Jonathan Novoa, Dragan Ljolje, Liliana Jazmín Cortés, Wilmer Marquiño, Maria Paz Ade, Wilman Yurgaky, Naomi W. Lucchi, Roberta Horth, Martha C. Renteria |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Adult
Male medicine.medical_specialty Artemether/lumefantrine Adolescent 030231 tropical medicine Plasmodium falciparum Drug Resistance Colombia Polymorphism Single Nucleotide law.invention 03 medical and health sciences Antimalarials Young Adult 0302 clinical medicine law Virology Internal medicine parasitic diseases Clinical endpoint medicine Humans Malaria Falciparum Child Genotyping Polymerase chain reaction Genetic testing Aged medicine.diagnostic_test biology business.industry Artemether Lumefantrine Drug Combination Age Factors Articles Middle Aged biology.organism_classification medicine.disease First line treatment Infectious Diseases Treatment Outcome Child Preschool Parasitology Female business Malaria medicine.drug |
Zdroj: | Am J Trop Med Hyg |
Popis: | Artemether–lumefantrine (AL) is the first-line treatment for uncomplicated Plasmodium falciparum infection in Colombia. To assess AL efficacy for uncomplicated falciparum malaria in Quibdo, Choco, Colombia, we conducted a 28-day therapeutic efficacy study (TES) following the WHO guidelines. From July 2018 to February 2019, febrile patients aged 5–65 years with microscopy-confirmed P. falciparum mono-infection and asexual parasite density of 250–100,000 parasites/µL were enrolled and treated with a supervised 3-day course of AL. The primary endpoint was adequate clinical and parasitological response (ACPR) on day 28. We attempted to use polymerase chain reaction (PCR) genotyping to differentiate reinfection and recrudescence, and conducted genetic testing for antimalarial resistance–associated genes. Eighty-eight patients consented and were enrolled; four were lost to follow-up or missed treatment doses. Therefore, 84 (95.5%) participants reached a valid endpoint: treatment failure or ACPR. No patient remained microscopy positive for malaria on day 3, evidence of delayed parasite clearance and artemisinin resistance. One patient had recurrent infection (12 parasites/µL) on day 28. Uncorrected ACPR rate was 98.8% (83/84) (95% CI: 93.5–100%). The recurrent infection sample did not amplify during molecular testing, giving a PCR-corrected ACPR of 100% (83/83) (95% CI: 95.7–100%). No P. falciparum kelch 13 polymorphisms associated with artemisinin resistance were identified. Our results support high AL efficacy for falciparum malaria in Choco. Because of the time required to conduct TESs in low-endemic settings, it is important to consider complementary alternatives to monitor antimalarial efficacy and resistance. |
Databáze: | OpenAIRE |
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