Comparison of the efficacy of artemether-lumefantrine vs. artesunate plus sulfadoxine-pyrimethamine in children with uncomplicated falciparum malaria

Rachmawati Rachmawati; Novie H Rampengan; Suryadi N N Tatura; Tonny H Rampengan

doi:10.14238/pi50.2.2010.113-7

Rachmawati Rachmawati Department of Child Health, Medical School, Sam Ratulangi University, Prof. R.D. Kandou General Hospital
Novie H Rampengan Department of Child Health, Medical School, Sam Ratulangi University, Prof. R.D. Kandou General Hospital
Suryadi N N Tatura Department of Child Health, Medical School, Sam Ratulangi University, Prof. R.D. Kandou General Hospital
Tonny H Rampengan Department of Child Health, Medical School, Sam Ratulangi University, Prof. R.D. Kandou General Hospital

DOI: https://doi.org/10.14238/pi50.2.2010.113-7

Keywords: artesunate, sulfadoxine-pyrimethamine, artemether, lumefantrine

Abstract

Background World Health Organization (WHO) has recommended
that countries with drug resistant malaria problem use
combination therapies, especially artemisinin-based combination
therapy (ACT). However, there is limited information on the
efficacy of ACT in North Sulawesi.
Objective To compare the efficacy of artemether-lumefanttine and
artesunate plus sulfadoxine-pyrimethamine (SP).
Methods This was a randomized experimental study, conducted in
Prof. Dr. R. D. Kandou General Hospital, Manado from January
until July 2009. There were 42 patients aged less than 13 years
treated with artemether-lumefanttine and artesunate plus SP. Body
temperature, parasite and gametocyte count were recorded every
day until day 7 and follow-up reviews were done on day 14 and
28.
Results Fever clearance time showed a significant difference
between artemether-lumefanttine group (median 27 hours) and
artesunate plus SP group (median 18 hours), P<0.05). There was
no significant difference in parasite clearance time (P>0.05) and
game tocyte clearance time (P > 0. 05) . The 28 day cure rate were
100% in the two groups. No side effect was found.
Conclusion Both artemether-lumefanttine and artesunate plus SP
combination are effective and safe for the treatment of falciparum
malaria in children.

References

1. Departemen Kesehatan RI. Pedoman Penatalaksanaan Kasus
Malaria di Indonesia. Jakarta: 2006.
2. Tandayu SA. Masalah data malaria di Sulawesi Utara. In:
Tambajong EH, ed. Penanganan malaria secara terpadu.
Manado: FK Universitas Sam Ratulangi, 1993 ;p.15 5-63.
3. Rampengan TH, RampenganJ. Chloroquine resistant falciparum
malaria in children. Pediatr Indones. 1989; 29:13-9.
4. Rampengan J, Rampengan TH. Malaria falsiparum pada
anak yang resisten II terhadap Fansidar. Maj Kedokt Indones.
1998;38:77-80.
5. Rampengan J, Mulyanto A, Kaunang ED. Malaria falsiparum
pada anak yang resisten II terhadap kina sulfat. Maj Farmakol
Ter Indones 2000; 13 :4-7.
6. Kan EF, Posumah MD, Wiriadinata S. Resistensi clan respon
pengobatan klorokuin terhadap pasien malaria falsiparum. In:
Firmansyah A, Trihono P, Oswari H, editors. Buku abstrak
KONIKA XI. Jakarta: Ikatan Dokter Anak Indonesia Pusat
Jakarta,1999; p.297.
7. Makanga M, Premji Z, Falade C. Efficacy and safety of the
six-dose regimen of artemether- lumefantrine in pediatrics
with uncomplicated plasmodium falciparum malaria : a
pooled analysis of individual patient data. Am J Trop Med
Hyg. 2006; 74: 991-8.
8. Roll Back Malaria/ World Health Organization. Position of
WHO's Roll Back Malaria Department on malaria treatment
policy [homepage on the internet]. c2004. Available from:
http://www.who.int/ malaria/docs/who_ apt _position.htm.
10. Van de Broek I, Kitz C, Attas S. Efficacy of three artemisinin
combination therapies for the treatment of uncomplicated
Plasmodium falciparum malaria in the Republic of Congo.
Malaria}. 2006;5:113.
11. Kshirsagar N.A, Gogtay N.J, Moorthy N.S. A randomized,
double-blind, parallel-group, comparative safety, and efficacy
trial of oral co-artemether versus oral chloroquine in the
treatment of acute uncomplicated Plasmodium falciparum
malaria in adults in India. Am J Trop Med Hyg. 2000;
63:402-8.
12. Guthmann JP, Cohuet S, Rigutto C. Short report: high
efficacy of two artemisinin-based combinations (artesunat
+ amodiaquine and artemether + lumefantrine) in Caala,
Central Angola. Am J Trop Med Hyg. 2006;75:143-5.
13. Novartis. Coartem monograph [homepage on the internet].
c2001. Available from : http://www.hanmat.org/coartem
2001.
14. Alecrim G.M, Lacerda V.M, Mouraq P.M. Successful treatment
of Plasmodium falciparum malaria with a six-dose regimen
of artemether-lumefantrine versus quinine-doxycycline in
the western Amazon region of Brazil. Am J Trop Med Hyg.
2006;74:20-5.
15. Mukhtar EA, Gadalla NB, El-Zaki SE. A comparative
study on the efficacy of artesunate plus sulphadoxine/
pyrimethamine versus artemether- lumefantrine in eastern
Sudan. Malaria J. 2007;6:92.
16. Sagara I, Dicko A, Djimde A. A randomized trial of artesunatsulfamethoxypyrazine
- pyrimethamine versus artemetherlumefantrine
for the treatment of uncomplicated Plasmodium
falciparum malaria in Mali. Am J Trop Med Hyg. 2006;
75 :630-6.