Therapeutic efficacy of Artemether/Lumefantrine (Coartem (R)) against Plasmodium falciparum in Kersa, South West Ethiopia

Abstract

Artemether/Lumefantrine (Coartem®) has been used as a first-line treatment for uncomplicatedPlasmodium falciparum infection since 2004 in Ethiopia. In the present study the therapeutic efficacy of artemether/lumefantrine for the treatment of uncomplicated P. falciparum infection at Kersa, Jima zone, South-west Ethiopia,has been assessed.Methods: A 28 day therapeutic efficacy study was conducted between November 2007 and January 2008, inaccordance with the 2003 WHO guidelines. Outcomes were classified as early treatment failure (ETF), late clinicalfailure (LCF), late parasitological failure (LPF) and adequate clinical and parasitological response (ACPR).Results: 90 patients were enrolled and completed the 28 day follow-up period after treatment with artemether/lumefantrine. Cure rate was very high, 96.3%, with 95% CI of 0.897-0.992 (PCR uncorrected). Age-stratified datashowed adequate clinical and parasitological response (ACPR) to be 100% for children under 5 and 97.4% and87.3% for children aged 5-14, and adults, respe ctively. There was no early treatment failure (ETF) in all age groups.Fever was significantly cleared on day 3 (P < 0.05) and 98% of parasites where cleared on day 1 and almost allparasites were cleared on day 3. 72.5% of gametocytes were cleared on day 1, the remaining 27.5% ofgametocytes were maintained up to day 3 and total clearance was observed on day 7. Hemoglobin concentrationshowed a slight increase with parasitic clearance (P > 0.05). No major side effect was observed in the study exceptthe occurrence of mouth ulcers in 7% of the patients.Conclusions: The current study proved the excellent therapeutic efficacy of artemether/lumefantrine in the studyarea and the value of using it. However, the proper dispensing and absorption of the drug need to be emphasizedin order to utilize the drug for a longer period of time. This study recommends further study on the toxicity of thedrug with particular emphasis on the development of oral ulcers in children.