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Open Access Highly Accessed Research

Therapeutic efficacy of artemether-lumefantrine for Plasmodium vivax infections in a prospective study in Guyana

Daniel Eibach12*, Nicolas Ceron3, Karanchand Krishnalall4, Keith Carter5, Guillaume Bonnot1, Anne-Lise Bienvenu1 and Stéphane Picot1

Author Affiliations

1 Malaria Research Unit, CNRS UMR 5246, University Lyon 1, Faculty of Medicine, Lyon, France

2 European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

3 Pan-American Health Organization, Georgetown, Guyana

4 Vector Control Services, Malaria Control Programme, Ministry of Health Guyana, Georgetown, Guyana

5 Division of Disease Prevention and Control, Pan-American Health Organization, Washington, USA

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Malaria Journal 2012, 11:347  doi:10.1186/1475-2875-11-347

Published: 19 October 2012

Abstract

Background

In Guyana, chloroquine + primaquine is used for the treatment of vivax malaria. A worldwide increase of chloroquine resistance in Plasmodium vivax led to questioning of the current malaria treatment guidelines. A therapeutic efficacy study was conducted using artemether-lumefantrine + primaquine against P. vivax to evaluate a treatment alternative for chloroquine.

Methods

From 2009 to 2010, a non-controlled study in two hospitals in Guyana was conducted. A total 61 patients with P. vivax infection were treated with artemether-lumefantrine as a six-dose regimen twice a day for three days with additional 0.25 mg/kg/d primaquine at day 0 for 14 days. Clinical and parasitological parameters were followed on days 0,1,2,3,7,14 and 28 in agreement with WHO guidelines. Plasmodium vivax DNA from eight patients was analysed for pvmdr1, molecular marker of resistance.

Results

Artemether-lumefantrine cleared 100% of parasites on day 1, but two patients (3%) had recurrence of parasites on day 28, suggesting relapse. No pvmdr1 Y976F polymorphism was detected. The treatment regimen was well tolerated.

Conclusions

In Guyana, artemether-lumefantrine represents an adequate treatment option against P. vivax when combined with primaquine. Availability of this alternative will be of great importance in case of emerging chloroquine resistance against P. vivax.

Keywords:
Malaria; Plasmodium vivax; Artemether-lumefantrine; Chloroquine; Guyana