A comparative, randomized clinical trial of artemisinin/naphtoquine twice daily one day versus artemether/lumefantrine six doses regimen in children and adults with uncomplicated falciparum malaria in Côte d'Ivoire

• Published in: Malaria journal Vol. 8; no. 1; p. 148
• Main Authors: Toure, Offianan A, Penali, Louis K, Yapi, Jean-Didier, Ako, Berenger A, Toure, Walamtchin, Djerea, Kali, Gomez, Genevieve O, Makaila, Oyewole
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03-07-2009; BioMed Central; BMC
• Subjects: Adult; Antimalarials; Antimalarials - administration & dosage; Artemisinins; Artemisinins - administration & dosage; Causes of; Child; Children; Comparative analysis; Control; Cote d'Ivoire; Demographic aspects; Diseases; Dosage and administration; Drug Administration Schedule; Drug Combinations; Drug resistance in microorganisms; Drug therapy; Drug Therapy, Combination; Ethanolamines; Ethanolamines - administration & dosage; Female; Fluorenes; Fluorenes - administration & dosage; Follow-Up Studies; Health aspects; Humans; Life Sciences; Malaria; Malaria, Falciparum; Malaria, Falciparum - drug therapy; Malaria, Falciparum - parasitology; Male; Microbiology and Parasitology; Parasitology; Plasmodium falciparum; Plasmodium falciparum - drug effects; Plasmodium falciparum - isolation & purification; Polymerase Chain Reaction; Recurrence; Treatment Outcome; Cote d'Ivoire; Côte d'Ivoire
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/1475-2875-8-148

Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination anti-malarial therapy, including artemisinins, has been advocated to improve efficacy and limit the spread of resistance. The fixed combination of oral artemether-lumefantrine (AL) is highly effective and well-tolerated. Artemisinin/naphtoquine (AN) is a fixed-dose ACT that has recently become available in Africa. The objectives of the study were to compare the efficacy and safety of AN and AL for the treatment of uncomplicated falciparum malaria in a high transmission-intensity site in Ivory Coast.
We enrolled 122 participants aged 6 months or more with uncomplicated falciparum malaria. Participants were randomized to receive either artemisinin/naphtoquine or artemether/lumefantrine with variable dose according to their weight. Primary endpoints were the risks of treatment failure within 28 days, either unadjusted or adjusted by genotyping to distinguish recrudescence from new infection.
Among 125 participants enrolled, 123 (98.4%) completed follow-up. Clinical evaluation of the 123 participants showed that cumulative PCR-uncorrected cure rate on day 28 was 100% for artemisinin/naphtoquine and 98.4% for artemether/lumefantrine. Both artemisinin-based combinations effected rapid fever and parasite clearance.
These data suggest that Arco could prove to be suitable for use as combination antimalarial therapy. Meanwhile, pharmacokinetic studies and further efficacy assessment should be conducted before its widespread use can be supported.