Treatment of severe sepsis with artemether-lumefantrine is associated with decreased mortality in ugandan patients without malaria

Abstract

We enrolled 382 patients at two hospitals in Uganda in a prospective observational study of severe sep-sis. Because artemisinins improve survival in murine sepsis models, we performed a post hoc analysis of the association between the use of artemether-lumefantrine (A-L) and mortality in patients with or without malaria. In patients with neg-ative malaria smears (N=328 of 379), Kaplan-Meier curves revealed decreased combined inpatient and 30-day mortal-ity among patients receiving A-L versus those who did not (20.6%, SE=10.6 versus 48.8%, SE=3.2; Log rank χ2=3.93, P=0.048). The decrease in mortality associated with A-L was maintained in the most clinically ill patients determined by Karnofsky Performance Scores ≥ 50 (16.7%, SE=15.2 versus 58.3%, SE=3.7; Log rank χ2 3.94, P=0.041). Research into the properties of A-L is needed to improve treatment of sepsis without compromising malarial susceptibility. Copyright © 2009 by The American Society of Tropical Medicine and Hygiene.