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A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya

BACKGROUND: Artemether-lumefantrine (AL) was adopted as first-line treatment for uncomplicated malaria in Kenya in 2006. Monitoring drug efficacy at regular intervals is essential to prevent unnecessary morbidity and mortality. The efficacy of AL and dihydroartemisinin-piperaquine (DP) were evaluate...

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Autores principales: Agarwal, Aarti, McMorrow, Meredith, Onyango, Peter, Otieno, Kephas, Odero, Christopher, Williamson, John, Kariuki, Simon, Kachur, Stephen Patrick, Slutsker, Laurence, Desai, Meghna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722085/
https://www.ncbi.nlm.nih.gov/pubmed/23870627
http://dx.doi.org/10.1186/1475-2875-12-254
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author Agarwal, Aarti
McMorrow, Meredith
Onyango, Peter
Otieno, Kephas
Odero, Christopher
Williamson, John
Kariuki, Simon
Kachur, Stephen Patrick
Slutsker, Laurence
Desai, Meghna
author_facet Agarwal, Aarti
McMorrow, Meredith
Onyango, Peter
Otieno, Kephas
Odero, Christopher
Williamson, John
Kariuki, Simon
Kachur, Stephen Patrick
Slutsker, Laurence
Desai, Meghna
author_sort Agarwal, Aarti
collection PubMed
description BACKGROUND: Artemether-lumefantrine (AL) was adopted as first-line treatment for uncomplicated malaria in Kenya in 2006. Monitoring drug efficacy at regular intervals is essential to prevent unnecessary morbidity and mortality. The efficacy of AL and dihydroartemisinin-piperaquine (DP) were evaluated for the treatment of uncomplicated malaria in children aged six to 59 months in western Kenya. METHODS: From October 2010 to August 2011, children with fever or history of fever with uncomplicated Plasmodium falciparum mono-infection were enrolled in an in vivo efficacy trial in accordance with World Health Organization (WHO) guidelines. The children were randomized to treatment with a three-day course of AL or DP and efficacy outcomes were measured at 28 and 42 days after treatment initiation. RESULTS: A total of 137 children were enrolled in each treatment arm. There were no early treatment failures and all children except one had cleared parasites by day 3. Polymerase chain reaction (PCR)-uncorrected adequate clinical and parasitological response rate (ACPR) was 61% in the AL arm and 83% in the DP arm at day 28 (p = 0.001). PCR-corrected ACPR at day 28 was 97% in the AL group and 99% in the DP group, and it was 96% in both arms at day 42. CONCLUSIONS: AL and DP remain efficacious for the treatment of uncomplicated malaria among children in western Kenya. The longer half-life of piperaquine relative to lumefantrine may provide a prophylactic effect, accounting for the lower rate of re-infection in the first 28 days after treatment in the DP arm.
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spelling pubmed-37220852013-07-25 A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya Agarwal, Aarti McMorrow, Meredith Onyango, Peter Otieno, Kephas Odero, Christopher Williamson, John Kariuki, Simon Kachur, Stephen Patrick Slutsker, Laurence Desai, Meghna Malar J Research BACKGROUND: Artemether-lumefantrine (AL) was adopted as first-line treatment for uncomplicated malaria in Kenya in 2006. Monitoring drug efficacy at regular intervals is essential to prevent unnecessary morbidity and mortality. The efficacy of AL and dihydroartemisinin-piperaquine (DP) were evaluated for the treatment of uncomplicated malaria in children aged six to 59 months in western Kenya. METHODS: From October 2010 to August 2011, children with fever or history of fever with uncomplicated Plasmodium falciparum mono-infection were enrolled in an in vivo efficacy trial in accordance with World Health Organization (WHO) guidelines. The children were randomized to treatment with a three-day course of AL or DP and efficacy outcomes were measured at 28 and 42 days after treatment initiation. RESULTS: A total of 137 children were enrolled in each treatment arm. There were no early treatment failures and all children except one had cleared parasites by day 3. Polymerase chain reaction (PCR)-uncorrected adequate clinical and parasitological response rate (ACPR) was 61% in the AL arm and 83% in the DP arm at day 28 (p = 0.001). PCR-corrected ACPR at day 28 was 97% in the AL group and 99% in the DP group, and it was 96% in both arms at day 42. CONCLUSIONS: AL and DP remain efficacious for the treatment of uncomplicated malaria among children in western Kenya. The longer half-life of piperaquine relative to lumefantrine may provide a prophylactic effect, accounting for the lower rate of re-infection in the first 28 days after treatment in the DP arm. BioMed Central 2013-07-19 /pmc/articles/PMC3722085/ /pubmed/23870627 http://dx.doi.org/10.1186/1475-2875-12-254 Text en Copyright © 2013 Agarwal et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Agarwal, Aarti
McMorrow, Meredith
Onyango, Peter
Otieno, Kephas
Odero, Christopher
Williamson, John
Kariuki, Simon
Kachur, Stephen Patrick
Slutsker, Laurence
Desai, Meghna
A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya
title A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya
title_full A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya
title_fullStr A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya
title_full_unstemmed A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya
title_short A randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western Kenya
title_sort randomized trial of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated malaria among children in western kenya
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722085/
https://www.ncbi.nlm.nih.gov/pubmed/23870627
http://dx.doi.org/10.1186/1475-2875-12-254
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