Malaria parasite clearance from patients following artemisinin-based combination therapy in Côte d’Ivoire

Abstract

IntroductionParasite clearance is useful to detect artemisinin resistance. The aim of this study was to investigate parasite clearance in patients treated with artesunate + amodiaquine (AS + AQ) and artemether + lumefantrine (AL): the two artemisinin-based combination therapies (ACTs) recommended in the first-line treatment of uncomplicated malaria in Côte d’Ivoire.MethodsThis study was conducted in Bouaké, Côte d’Ivoire, from April to June 2016. Patients aged at least 6 months with uncomplicated malaria and treated with AS + AQ or AL were hospitalized for 3 days, and follow-up assessments were performed on days 3, 7, 14, 21, 28, 35, and 42. Blood smears were collected at the time of screening, pre-dose, and 6-hour intervals following the first dose of administration until two consecutive negative smears were recorded, thereafter at day 3 and follow-up visits. Parasite clearance was determined using the Worldwide Antimalarial Resistance Network’s parasite clearance estimator. The primary end points were parasite clearance rate and time.ResultsA total of 120 patients (57 in the AS + AQ group and 63 in the AL group) were randomized among 298 patients screened. The median parasite clearance time was 30 hours (IQR, 24–36 hours), for each ACT. The median parasite clearance rate had a slope half-life of 2.36 hours (IQR, 1.85–2.88 hours) and 2.23 hours (IQR, 1.74–2.63 hours) for AS + AQ and AL, respectively. The polymerase chain reaction-corrected adequate clinical and parasitological response was 100% and 98.07% at day 42 for AS + AQ and AL, respectively.ConclusionPatients treated with AS + AQ and AL had cleared parasites rapidly. ACTs are still efficacious in Bouaké, Côte d’Ivoire, but continued efficacy monitoring of ACTs is needed.

Trends and predictive factors for treatment failure following artemisinin-based combination therapy among children with uncomplicated malaria in Ghana: 2005–2018

“…The study has shown that day 3 parasitaemia, which is an indicator of artemisinin or partial resistance [ 22 ] has remained less than 1% with no statistically significant increase in proportions between 2005 (0.2%) and 2018 (0.6%). This finding suggests that artemisinin remains a viable component of combination therapy in the management of uncomplicated malaria in Ghana, and compares well with findings in the sub-region [ 23 – 25 ].…”

Investigating the Effect of Prompt Treatment on Malaria Prevalence in Children Aged below Five Years in Zambia: A Nested Case-Control Study in a Cross-Sectional Survey

“…is is consistent with other studies that studied malaria determinants in Zambia [27,28]. Antimalarial drugs such as artemisinin combination therapies (ACTs) are known to clear parasiteamia within few days of commencement of effective treatment; one study in Cote d'Ivoire found a median parasite clearance of 30 hrs [29]. Another study recommended a day-three blood slide as a good predictor of treatment success [30].…”

Influence of Host-Related Factors and Exposure to Mosquito Bites on the Dynamics of Antibody Response to Plasmodium falciparum Antigens

“…The study was carried out during a clinical trial that aimed to assess the in vivo efficacy of artemisinin-based anti-malarial combination therapies. Details of the study, clinical procedures, and drug administration are described elsewhere [ 45 ]. Briefly, patients ( n = 120, age > 6 months) with uncomplicated malaria and monospecific P. falciparum infestation confirmed by microscopy (parasite density between 2000 and 200,000 asexual parasites/μL of blood), axillary temperature of ≥37.5 °C, or a history of fever over the past 24 h, with body weight ≥5 kg, and who were able to take oral medications and follow study procedures were included in the study.…”