Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: Pharmacokinetic and dosage-related findings from a clinical trial in Uganda

56Citations
Citations of this article
102Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Background: A six-dose antimalarial regimen of artemether-lumefantrine (A/L) may soon become one of the most widely used drug combination in Africa, despite possible constraints with adherence and poor absorption due to inadequate nutrition, and a lack of pharmacokinetic and effectiveness data. Methods: Within a trial of supervised versus unsupervised A/L treatment in a stable Ugandan Plasmodium falciparum transmission setting, plasma lumefantrine concentrations were measured in a subset of patients on day 3 (C [lum] day3) and day 7 (C [lum]day7) post-inclusion. Predictors of lumefantrine concentrations were analysed to show how both C [lum] day7 and the weight-adjusted lumefantrine dose affect 28-day recrudescence and re-infection risks. The implications of these novel findings are discussed in terms of the emergence of lumefantrine-resistant strains in Africa. Results: C [lum]day3 and C [lum]day7 distributions among 241 supervised and 238 unsupervised patients were positively skewed. Unsupervised treatment and decreasing weight-adjusted lumefantrine dose were negatively associated with C [lum]day3. Unsupervised treatment and decreasing age showed strong negative associations with C [lum]day7. Both models were poorly predictive (R-squared < 0.25). There were no recrudescences in either arm, but decreasing lumefantrine dose per Kg resulted in up to 13-fold higher adjusted risks of re-infection. Re-infections occurred only among patients with C [lum]day7 below 400 ng/mL (p < 0.001). Conclusion: Maintaining the present six-dose regimen and ensuring high adherence and intake are essential to maximize the public health benefits of this valuable drug combination. © 2006 Checchi et al; licensee BioMed Central Ltd.

Cite

CITATION STYLE

APA

Checchi, F., Piola, P., Fogg, C., Bajunirwe, F., Biraro, S., Grandesso, F., … Guthmann, J. P. (2006). Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: Pharmacokinetic and dosage-related findings from a clinical trial in Uganda. Malaria Journal, 5. https://doi.org/10.1186/1475-2875-5-59

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free