Artesunate-amodiaquine treatment for children with uncomplicated malaria in Kalimantan and Sulawesi: clinical complaints, tolerability and compliance

Main Article Content

Retno Gitawati
Ani Isnawati
Emiliana Tjitra
Mariana Raini
Ondri Dwi Sampurno
Indri Rooslamiati

Abstract

Background Artesunate-amodiaquine combination (AS+ AQ)
is one type of artemisinin-based combination therapy (ACT) and
has been used in Indonesia since 2004 for uncomplicated malaria,
both in adults and children. However, its use in the Indonesia
Malaria Program has not yet been evaluated.
Objective To evaluate the clinical complaints and tolerability
to AS+AQ treatment, as well as compliance in children with
uncomplicated malaria.
Methods This was a cross-sectional study, conducted in sentinel
puskesmas (primary health centers) in Kalimantan and Sulawesi.
Subjects were 126 children aged under 15 years, with P. falciparum,
P. vivax, or mixed falciparum-vivax malaria infections. All subjects
were treated with a single dose of AS+AQ for three consecutive
days and followed-up 3 times (D3, D7 and D28) to record clinical
complaints and tolerability after drug administration. Parents/
guardians underwent in-depth interviews on the knowledge,
attitudes and practices of the ACT used as well as clinical
complaints following AS+ AQ treatment.
Results Of the 126 subjects evaluated, 30 were infected with P.
falciparum, 5 9 with P. vivax, and 3 7 with both species. About 84% of
the subjects reported clinical complaints after AS+ AQ administration
(DO-DZ), most commonly lethargy, nausea and vomiting, similar to
the clinical symptoms of malaria. All complaints were reported to be
mild and tolerable. Only one subject was lost to follow-up.
Conclusion Clinical complaints experienced by malaria-infected
children following AS+AQ treatment were relatively tolerable.
Subjects' compliance to AS+ AQ treatment was satisfactory.
[Paediatr lndones. 2012;52:10-5).

Article Details

How to Cite
1.
Gitawati R, Isnawati A, Tjitra E, Raini M, Sampurno O, Rooslamiati I. Artesunate-amodiaquine treatment for children with uncomplicated malaria in Kalimantan and Sulawesi: clinical complaints, tolerability and compliance. PI [Internet]. 30Mar.2012 [cited 21Sep.2020];52(1):10-5. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/292
Section
Articles
Received 2016-08-21
Accepted 2016-08-21
Published 2012-03-30

References

1. Laporan Riskesdas 2010. Badan Penelitian clan Pengembangan
Kesehatan. Draft Report. Jakarta: Indonesian Ministry of
Health; 2010.
2. Ministry of Health. Pedoman Penatalaksanaan Kasus Malaria
di Indonesia. Jakarta: General Directorate of Disease Control
and Enviromenral Health; 2009.
3. Ogbonnaya OC, Chika UE, Chukwuemeka UM, Chioma
EA, Achunike AP. Efficacy of artesunate-amodiaquine
combination therapy for uncomplicated malaria in patients
in South-Eastern Nigeria. J Appl Res. 2010;10: 17-23.
4. Navaratnam V, Ramanathan S, Wahab MS, Siew Hua G,
Mansor SM, Kiechel JR, et al. Tolerability and pharmacokinetics
of non-fixed and fixed combinations of artesunate
and amodiaquine in Malaysian healthy normal volunteers.
Eur J Clin Pharmacol. 2009;65:809-21.
5. Koram KA, Quaye Land Abuaku B. Efficacy of amodiaquine/
artesunate combination therapy for uncomplicated malaria
in children under five years in Ghana. Ghana Med J.
2008;42:55-60.
6. Asih PB, Dewi RM, Tuti S, Sadikin M, Sumarto W, Sinaga
B, et al. Efficacy of artemisinin-based combination therapy
for treatment of persons with uncomplicated Plasmodium
falciparum malaria in West Sumba District, East Nusa
Tenggara Province, Indonesia, and genotypic profiles of the
parasite. Am J Trop Med Hyg. 2009;80:914-8.
7. Syahril P, Pitaloka PA, Panusunan LC. Combination of
artesunate-amodiaquine as a treatment for uncomplicated
fa lciparum malaria in children. Pediatrics. 2008; 121: 133.
8. Djatmiko, W. Uji efikasi terapi kombinasi artesunate +
amodiaquine pada malaria faleiparum tanpa komplikasi di
Kabupaten Banjarnegara Propinsi Jawa Tengah [Master
thesis] . Semarang: Department of Internal Medicine,
Diponegoro University; 2005.
9. Hasugian AR, Purba HLE, Kenangalem E, Wuwung RM,
Ebsworth EP, Maristela R, et al. Dihydroartemisininpiperaquine
versus artesunate-amodiaquine: superior efficacy
and posttreatment prophylaxis against multidrug-resistant
Plasm.:xlium faleiparum and Plasmodium vivax malaria. Clin
Inf Dis. 2007;44: 1067-74.
10. Tjitra E, Siswantoro H, Gitawati R, Handayani S, Delima.
Monitoring drug resistance in subjects with Plasmodium
faleiparum and Plasmodium vivax in Kalimantan and Sulawesi:
studies in vivo, pharmacovigilance, molecular. Unpublished
research report. Badan Penehtian clan Pengembangan
Kesehatan, 2010. p3 l-50.
11. Poespoprodjo JR, Fobia W, Kenangalem E, Lampah
DA, Hasanuddin A,Warikar N, et al. Vivax malaria: a
major cause of morbidity in early infancy. Clin Inf Dis.
2009; 48: 1704- 12.
12. Gitawati R, Isnawati A, Raini M, Rooslamiati, I. Monitoring
drug resistance in subjects with Plasmodium faleiparum and
Plasmodium vivax in Kalimantan and Sulawesi: pharmacovigilance
study. Unpublished research report. Badan Penelitian
clan Pengembangan Kesehatan, 2010. p.21-3 1.
13. Adjuik M, Agnamey P, Babiker A, Borrmann S, Brasseur P,
Cisse M, et al. Amodiaquine-ar tesunate versus amodiaquine
for uncomplicated Plasmodium falciparum malaria in
African children: a randomised, multicentre trial. Lancet.
2002;359: 1365- 72.
14. Oyakhirome S, Potschke M, Schwarz NG, Dornemann J,
Laengin M, Salazar CO, et al. Artesunate-amodiaquine
combination therapy for falciparum malaria in young
Gabonese children. Malaria J. 2007;6:29.
15. Artavanis-Tsakonas K, Tongren JE and Riley EM. The
war between the malaria parasite and the immune system:
immunity, immunoregulation and immunopathology. Clin
Exp Immunol. 2003; 133:145-52.
16. Nunes MS, Ferreira MU. Clinical spectrum of un complicated
malaria in semi-immune Amazonians: beyond
the "symptomatic" vs "asymptomatic" dichotomy. Mem Inst
Oswaldo Cru z. 2007; 102:341-7.