Artemether-lumefantrine, mefloquine and atovaquone-proguanil in the treatment of uncomplicated Plasmodium falciparum malaria in travellers: A retrospective comparative study of efficacy and treatment failures
Language English Country Netherlands Media print-electronic
Document type Journal Article
PubMed
36792022
DOI
10.1016/j.tmaid.2023.102549
PII: S1477-8939(23)00009-1
Knihovny.cz E-resources
- Keywords
- Antimalarials, Artemether-lumefantrine, Artemisinin-based combination therapy, Atovaquone-proguanil, Malaria, Mefloquine, Travel medicine, Travellers,
- MeSH
- Antimalarials * adverse effects MeSH
- Artemether therapeutic use MeSH
- Adult MeSH
- Ethanolamines therapeutic use MeSH
- Drug Combinations MeSH
- Artemether, Lumefantrine Drug Combination therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Malaria * drug therapy MeSH
- Mefloquine therapeutic use adverse effects MeSH
- Treatment Failure MeSH
- Plasmodium falciparum MeSH
- Retrospective Studies MeSH
- Malaria, Falciparum * drug therapy epidemiology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- Antimalarials * MeSH
- Artemether MeSH
- atovaquone, proguanil drug combination MeSH Browser
- Ethanolamines MeSH
- Drug Combinations MeSH
- Artemether, Lumefantrine Drug Combination MeSH
- Mefloquine MeSH
BACKGROUND: The aim of this study was to evaluate the rates of parasitaemia clearance and the prevalence of treatment failure in patients with uncomplicated Plasmodium falciparum malaria treated with artemether-lumefantrine (AL), mefloquine (MQ), and atovaquone-proguanil (AP). METHOD: The retrospective descriptive study included adult patients with uncomplicated P. falciparum malaria treated at the University Hospital Bulovka in Prague from 2006 to 2019. Parasitaemia clearance was estimated using a linear regression model. RESULTS: The study included 72 patients with a median age of 33 years (IQR 27-45) and a male to female ratio of 3.2:1. Thirty-six patients (50.0%) were treated with AL, 27 (37.5%) with MQ and 9 (12.5%) with AP. The proportion of VFR and migrants was 22.2% with no significant differences among the three groups. The median time to the parasitaemia clearance was two days (IQR 2-3) in patients treated with AL versus four days in the MQ (IQR 3-4) and AP (IQR 3-4) groups, p < 0.001. The clearance rate constant was 3.3/hour (IQR 2.5-4.0) for AL, 1.6/hour (IQR 1.3-1.9) for MQ, and 1.9/hour (IQR 1.3-2.4) for AP, p < 0.001. Malaria recrudescence occurred in 5/36 (13.9%) patients treated with AL and in no patients treated with MQ or AP. CONCLUSIONS: The findings demonstrate the superior efficacy of AL compared to other oral antimalarials in early malaria treatment. However, we observed a higher rate of late treatment failure in patients treated with AL than previously reported. This issue warrants further investigation of possible dose adjustments, extended regimens, or alternative artemisinin-based combinations.
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