In-vivo efficacy of amodiaquine-artesunate in children with uncomplicated Plasmodium falciparum malaria in western Kenya |
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Authors: | J I Thwing C O Odero F O Odhiambo K O Otieno S Kariuki R Ord C Roper M McMorrow J Vulule L Slutsker R D Newman M J Hamel M Desai |
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Institution: | Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya; London School of Hygiene and Tropical Medicine, UK |
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Abstract: | Objectives To assess the efficacy of amodiaquine-artesunate in an area with high chloroquine resistance in western Kenya. Methods Twenty-eight day in-vivo efficacy trial of amodiaquine-artesunate in 103 children aged 6–59 months in western Kenya with smear-confirmed uncomplicated Plasmodium falciparum malaria. Results The 28-day uncorrected adequate clinical and parasitological response (ACPR) was 69.0%, with 15.5% Late Clinical Failure and 15.5% Late Parasitologic Failure rates. The PCR-corrected 28-day ACPR was 90.2%. Clinical risk factors for recurrent infection (recrudescences and reinfections) were lower axillary temperature at enrolment and low weight-for-age Z-score. The presence of single nucleotide polymorphisms pfcrt 76T and pfmdr1 86Y at baseline was associated with increased risk of recurrent infections, both reinfections and recrudescences. Conclusion Although artemether-lumefantrine (Coartem®) is the first line ACT in Kenya, amodiaquine-artesunate is registered as an option for treatment of uncomplicated P. falciparum and remains an effective alternative to Coartem® in western Kenya. Continued amodiaquine monotherapy in the private sector may jeopardise the future use of amodiaquine-artesunate as an alternative artemisinin-based combination therapy. |
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Keywords: | artemether-lumefantrine amodiaquine-artesunate malaria resistance chloroquine clinical trial Kenya |
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