Therapeutic efficacy and effects of artesunate-amodiaquine and artemether-lumefantrine on malaria-associated anaemia in Nigerian children aged two years and underReportar como inadecuado




Therapeutic efficacy and effects of artesunate-amodiaquine and artemether-lumefantrine on malaria-associated anaemia in Nigerian children aged two years and under - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Infectious Diseases of Poverty

, 5:70

First Online: 06 July 2016Received: 17 November 2015Accepted: 28 June 2016DOI: 10.1186-s40249-016-0165-2

Cite this article as: Sowunmi, A., Akano, K., Ayede, A.I. et al. Infect Dis Poverty 2016 5: 70. doi:10.1186-s40249-016-0165-2

Abstract

BackgroundArtemisinin-based combination therapies are recommended as first-line treatments for uncomplicated falciparum malaria, but there is little evaluation of their efficacy and effects on uncomplicated malaria-associated anaemia in children aged 2 years and under.

MethodsParasitological efficacy and effects on malaria-associated anaemia were evaluated in 250 malarious children aged 2 years and under, and efficacy was evaluated in 603 malarious children older than two but younger than 5 years of age following treatment with artesunate-amodiaquine AA or artemether-lumefantrine AL. Kinetics of the disposition of parasitaemia following treatment were evaluated using a non-compartment model. Late-appearing anaemia LAA was diagnosed using the following criteria: clearance of parasitaemia, fever and other symptoms occurring within 7 days of starting treatment, adequate clinical and parasitological response on days 28–42, haematocrit HCT ≥ 30 % at 1 and-or 2 weeks, a fall in HCT to < 30 % occurring at 3–6 weeks, absence of concomitant illness at 1–6 weeks, and absence of asexual parasitaemia detected using both microscopy and polymerase chain reaction PCR at 1–6 weeks.

ResultsOverall, in children aged 2 years and under, the PCR-corrected parasitological efficacy was 97.2 % 95 % CI 92.8–101.6, which was similar for both treatments. In children older than 2 years, parasitological efficacy was also similar for both treatments, but parasite prevalence 1 day after treatment began was significantly higher, and fever and parasite clearance times were significantly faster in the AA-treated children compared with the AL-treated children. Declines in parasitaemia were monoexponential with an estimated elimination half-time of 1 h. Elimination half-times were similar for both treatments. In children aged 2 years and under who were anaemic at presentation, the mean anaemia recovery time was 12.1 days 95 % CI 10.6–13.6, n = 127, which was similar for both treatments. Relatively asymptomatic LAA occurred in 11 children 4.4 % aged 2 years and under, the recovery from which was uneventful.

ConclusionThis study showed that AA and AL are efficacious treatments for uncomplicated falciparum malaria in Nigerian children aged 2 years and under, and that AA clears parasitaemia and fever significantly faster than AL in children older than 2 years. Both treatments may cause a relatively asymptomatic LAA with uneventful recovery in a small proportion of children aged 2 years and under.

Trials registrationPan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 http:-www.pactr.org.

KeywordsFalciparum malaria Malaria-related anaemia Young children Artemisinin-based combination therapies Nigeria Electronic supplementary materialThe online version of this article doi:10.1186-s40249-016-0165-2 contains supplementary material, which is available to authorized users.

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Autor: Akintunde Sowunmi - Kazeem Akano - Adejumoke I. Ayede - Godwin Ntadom - Elsie O. Adewoye - Bayo Fatunmbi - Temitope Adero

Fuente: https://link.springer.com/







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