Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal
Abstract Background The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal a...
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doaj-327dde0bc591496ca02d7ce879f7e4702020-11-25T02:07:42ZengBMCTropical Diseases, Travel Medicine and Vaccines2055-09362018-08-01411710.1186/s40794-018-0068-2Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in NepalPrakash Ghimire0Komal Raj Rijal1Chandramani Kafle2Balman Singh Karki3Nihal Singh4Leonard Ortega5Garib Das Thakur6Bipin Adhikari7Central Department of Microbiology, Tribhuvan UniversityCentral Department of Microbiology, Tribhuvan UniversityCentral Department of Microbiology, Tribhuvan UniversityKIST Medical CollegeWorld Health Organization, Country office Nepal, UN HouseGlobal Malaria Program, World Health Organization headquartersMinistry of Health, Government of NepalMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityAbstract Background The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013–2014). Methods Giemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000–10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance). Results A total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level. Conclusion Only one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.http://link.springer.com/article/10.1186/s40794-018-0068-2Artemether-lumefantrineACTTreatmentUncomplicated falciparumMalariaNepal |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Prakash Ghimire Komal Raj Rijal Chandramani Kafle Balman Singh Karki Nihal Singh Leonard Ortega Garib Das Thakur Bipin Adhikari |
spellingShingle |
Prakash Ghimire Komal Raj Rijal Chandramani Kafle Balman Singh Karki Nihal Singh Leonard Ortega Garib Das Thakur Bipin Adhikari Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal Tropical Diseases, Travel Medicine and Vaccines Artemether-lumefantrine ACT Treatment Uncomplicated falciparum Malaria Nepal |
author_facet |
Prakash Ghimire Komal Raj Rijal Chandramani Kafle Balman Singh Karki Nihal Singh Leonard Ortega Garib Das Thakur Bipin Adhikari |
author_sort |
Prakash Ghimire |
title |
Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal |
title_short |
Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal |
title_full |
Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal |
title_fullStr |
Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal |
title_full_unstemmed |
Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal |
title_sort |
efficacy of artemether-lumefantrine for the treatment of uncomplicated plasmodium falciparum malaria in nepal |
publisher |
BMC |
series |
Tropical Diseases, Travel Medicine and Vaccines |
issn |
2055-0936 |
publishDate |
2018-08-01 |
description |
Abstract Background The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013–2014). Methods Giemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000–10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance). Results A total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level. Conclusion Only one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal. |
topic |
Artemether-lumefantrine ACT Treatment Uncomplicated falciparum Malaria Nepal |
url |
http://link.springer.com/article/10.1186/s40794-018-0068-2 |
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