Persistence of High In Vivo Efficacy and Safety of Artesunate–Amodiaquine and Artemether–Lumefantrine as the First- and Second-Line Treatments for Uncomplicated Plasmodium falciparum Malaria 10 Years After Their Implementation in Gabon

• Published in: Acta parasitologica Vol. 64; no. 4; pp. 898 - 902
• Main Authors: Ndong Ngomo, Jacques M., Ondzagha Megnie, Guy J., Moutombi Ditombi, Bridy, Koumba Lengongo, Jeanne V., M’Bondoukwé, Noé P., Offouga, Christelle L., Mawili-Mboumba, Denise P., Lekana-Douki, Jean B., Ringwald, Pascal, Fandeur, Thierry, Bouyou-Akotet, Marielle K.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2019; Springer Nature B.V
• Subjects: Amodiaquine; Amodiaquine - adverse effects; Amodiaquine - therapeutic use; Animal Systematics/Taxonomy/Biogeography; Artemether; Artemether, Lumefantrine Drug Combination - adverse effects; Artemether, Lumefantrine Drug Combination - therapeutic use; Artemisinin; Artemisinins - adverse effects; Artemisinins - therapeutic use; Artesunate; Biomedical and Life Sciences; Biomedicine; Child; Child, Preschool; Children; Drug Combinations; Ecology; Erythrocytes; Evaluation; Failure rates; Gabon; Health centres; Humans; Infant; Malaria; Malaria, Falciparum - drug therapy; Medical Microbiology; Microbiology; Morbidity; Original Paper; Parasite resistance; Parasitology; Plasmodium falciparum; Prospective Studies; Sentinel Surveillance; Treatment Outcome; Vector-borne diseases; Gabon; Therapeutic efficacy; Gabon; ACT; Safety; Plasmodium falciparum
• ISSN: 1230-2821; 1896-1851
• DOI: 10.2478/s11686-019-00115-y

Purpose
Artesunate–amodiaquine (AS–AQ) and artemether–lumefantrine (AL) have been widely used for the treatment of uncomplicated
Plasmodium falciparum
malaria since 2005 in Gabon. Since 2011, a rebound of malaria morbidity has been observed in this country, while no survey evaluating ACT efficacy was performed. During the same period, parasite resistance against artemisinin has been reported in Asia. The aim of this study was to assess the efficacy and tolerability of these two drugs in two sentinel sites of Gabon 10 years after their implementation.
Methods
Children aged from 12 to 144 months with uncomplicated malaria were recruited at the Regional Hospital of Melen, Libreville and in the Urban Health Center of Franceville between March 2014 and September 2015. The therapeutic efficacy was evaluated according to the WHO 2008 protocol of 28-day follow-up and PCR-uncorrected/corrected treatment outcomes were assessed.
Results
One hundred and eighty-five children (98 ASAQ and 89 AL) were followed up until day 28. The PCR-corrected ACPR was 98.9% for AS–AQ and 96.4% for AL. Late therapeutic failure rate was 3.6% and 1.1% for AL and AS–AQ, respectively (
p
 = 0.2). Adverse events and serious adverse events were rarely observed with both treatments.
Conclusion
AS–AQ and AL are still efficacious and well-tolerated for the treatment of uncomplicated malaria in Gabonese children.