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Open Access Research

Exploration of in vivo efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in under fives in Tabora region, Tanzania

Deokary Joseph13, Abdunoor M Kabanywanyi2, Ruth Hulser3, Zulfiqarali Premji4, Omary MS Minzi4 and Kefas Mugittu5*

Author Affiliations

1 Dar es Salaam University College of Education, PO Box 2329, Dar es Salaam, Tanzania

2 Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania

3 St Phillip’s Health Centre, PO Box 1408, Tabora, Tanzania

4 Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania

5 Ifakara Health Institute, PO Box 74, Bagamoyo, Tanzania

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Malaria Journal 2013, 12:60  doi:10.1186/1475-2875-12-60

Published: 11 February 2013

Abstract

Background

Tanzania adopted artemether-lumefantrine (AL) as first-line drug for uncomplicated malaria in 2006. Recently, there was an anecdotal report on high malaria recurrence rate following AL treatment in in the (urban and peri-urban), western part of Tanzania. The current report is an exploratory study to carefully and systematically assess AL efficacy in the area.

Methods

Between June and August 2011, a total of 1,126 patients were screened for malaria, 33 had malaria, of which 20 patients met inclusion criteria and were enrolled and treated with standard dose of AL as recommended in the WHO protocol. Treated patients were followed up for 28 days to assess treatment responses. Before treatment (Day 0) and post-treatment (Day 7) plasma lumefantrine levels were determined to assess prior AL use and ascertain parasites exposure to adequate plasma leveles of lumefantrine, respectively.

Results

The cure rate was 100%. All Day 0 plasma lumefantrine were below HPLC detectable level. The median Day 7 lumefantrine concentration was 404, (range, 189–894 ng/ml). Six out of 20 patients (30%) were gametocytaemic and all cleared gametocytes by Day 14. One patient showed an increase in gametocytes from four on Day 0 to 68, per 500 WBC on Day 2.

Conclusion

Artemether lumefantrine is highly efficacious against uncomplicated Plasmodium falciparum malaria. The elevation of gametocytaemia despite AL treatment needs to be evaluated in a larger study.