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Open Access Research

Open-label trial of three dosage regimens of fixed-dose combination of artemisinin and naphthoquine for treating uncomplicated falciparum malaria in calabar, Nigeria

Martin M Meremikwu12*, Friday Odey12, Chioma Oringanje1, Angela Oyo-ita13, Emmanuel Effa14, Ekpereonne B Esu15, Eyam Eyam1, Olabisi Oduwole1, Vivian Asiegbu1, Ambrose Alaribe16 and Emmanuel N Ezedinachi14

Author Affiliations

1 Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, Nigeria

2 Department of Paediatrics, University of Calabar, Calabar, Nigeria

3 Department of Community Medicine, University of Calabar, Calabar, Nigeria

4 Department of Internal Medicine, University of Calabar, Calabar, Nigeria

5 Department of Public Health, University of Calabar, Calabar, Nigeria

6 Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria

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Malaria Journal 2012, 11:413  doi:10.1186/1475-2875-11-413

Published: 11 December 2012

Abstract

Background

The use of anti-malarial drug combinations with artemisinin, or with one of its derivatives, is now widely recommended to overcome drug resistance in falciparum malaria. Fixed-dose combination of artemisinin and naphthoquine is a new generation artemisinin combination therapy (ACT) offered as a single dose therapy. The aim of the study was to assess the therapeutic efficacy, safety and tolerability of three dosage schedules of fixed-dose combination of artemisinin (125 mg) and naphthoquine (50 mg) for treating uncomplicated Plasmodium falciparum malaria among adolescents and adults in Calabar, South-east Nigeria.

Method

A total of 121 patients aged ≥15 years with uncomplicated P. falciparum malaria were enrolled and randomly assigned to three dosage schedules: (A) 700 mg (four tablets) single dose; (B) 700 mg 12-hourly x two doses; and (C) 1,400 mg (eight tablets) single dose. Patients were observed for 28 days, with clinical, parasitological, and haematological assessments.

Results

A total of 108 patients completed the study. The overall 28-day cure rate was 88.9%. Day 28-cure rates of the three dosage schedules were 85.3%, 93.1% and 88.9% for Group A, B and C respectively. Adverse events were few and mild, the commonest being weakness and headache; there was no serious adverse event.

Conclusion

Concerns for emergence of parasite resistance due to the use of artemisinin-naphthoquine as single dose regimen is likely to compromise the usefulness of this potentially important combination treatment. A robust multi-centre trial is recommended to evaluate a three-day regimen with potentials to achieve high cure rates while minimizing the risk of emergence of resistant parasite strains.

Keywords:
Falciparum malaria; Artemisinin; Naphthoquine; Combination therapy