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Sustained High Cure Rate of Artemether-Lumefantrine against Uncomplicated Plasmodium falciparum Malaria after 8 Years of Its Wide-Scale Use in Bagamoyo District, Tanzania
Muhimbili Univ Hlth & Allied Sci, Dept Parasitol & Med Entomol, POB 65011, Dar Es Salaam, Tanzania..
Muhimbili Univ Hlth & Allied Sci, Dept Parasitol & Med Entomol, POB 65011, Dar Es Salaam, Tanzania..
Karolinska Inst, Div Pharmacogenet, Dept Physiol & Pharmacol, Drug Resistance Unit, Stockholm, Sweden..
Swedish Univ Agr Sci, Virol Sect, Dept Biomed Sci & Vet Publ Hlth, Uppsala, Sweden..ORCID iD: 0000-0002-4506-0408
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2017 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 97, no 2, p. 526-532Article in journal (Refereed) Published
Abstract [en]

We assessed the temporal trend of artemether-lumefantrine (AL) cure rate after 8 years of its wide-scale use for treatment of uncomplicated Plasmodium falciparum malaria from 2006 to 2014 in Bagamoyo district, Tanzania. Trend analysis was performed for four studies conducted in 2006, 2007-2008, 2012-2013, and 2014. Patients with acute uncomplicated P. falciparum malaria were enrolled, treated with standard AL regimen and followed-up for 3 (2006), 28 (2014), 42 (2012-2013), or 56 (2007-2008) days for clinical and laboratory evaluation. Primary outcome was day 28 polymerase chain reaction (PCR)-adjusted cure rate across years from 2007 to 2014. Parasite clearance was slower for the 2006 and 2007-2008 cohorts with less than 50% of patients cleared of parasitemia on day 1, but was rapid for the 2012-2013 and 2014 cohorts. Day 28 PCR-adjusted cure rate was 168/170 (98.8%) (95% confidence interval [CI], 97.2-100), 122/127 (96.1%) (95% CI, 92.6-99.5), and 206/207 (99.5%) (95% CI, 98.6-100) in 2007-2008, 2012-2013, and 2014, respectively. There was no significant change in the trend of cure rate between 2007 and 2014 (chi(2)(trend) test = 0.06, P = 0.90). Pretreatment P. falciparum multidrug-resistant gene 1 (Pfmdr1) N86 prevalence increased significantly across years from 13/48 (27.1%) in 2006 to 183/213 (85.9%) in 2014 (P < 0.001), and P. falciparum chloroquine resistance transporter gene (Pfcrt) K76 prevalence increased significantly from 24/47 (51.1%) in 2006 to 198/205 (96.6%) in 2014 (P < 0.001). The AL cure rate remained high after 8 years of its wide-scale use in Bagamoyo district for the treatment of uncomplicated P. falciparum malaria despite an increase in prevalence of pretreatment Pfmdr1 N86 and Pfcrt K76 between 2006 and 2014.

Place, publisher, year, edition, pages
AMER SOC TROP MED & HYGIENE , 2017. Vol. 97, no 2, p. 526-532
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-345139DOI: 10.4269/ajtmh.16-0780ISI: 000423197200033PubMedID: 28829723OAI: oai:DiVA.org:uu-345139DiVA, id: diva2:1189589
Funder
Sida - Swedish International Development Cooperation AgencyAvailable from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-03-12Bibliographically approved

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Mårtensson, Andreas

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