Efficacy and safety of artemether- lumefantrine and artesunate - amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Mainland Tanzania
National Institute for Medical Research
176 participants
May 1, 2022
Interventional
Conditions
Summary
Febrile children aged 6 months to 10 years were recruited to evaluate the efficaxy and safety of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated P. falciparum malaria infections in Tanzania. Artemether-lumefantrine or artesunate-amodiaquine was given under direct supervision and clinical and parasitological parameters were monitored for 28 days follow-up to establish proportion of patients with PCR corrected treatment failure and frequency of adverse events. Polymorphism of molecular markers for artemisinin and partner drug resistance resistance as well hrp2/3 deletion were investigated on day 0 samples.
Eligibility
Inclusion Criteria8
- age from six months to 10 years
- malaria Rapid Diagnostic Test (mRDT) positive
- mono-infection with P. falciparum confirmed by positive blood smear (i.e. no mixed infection);
- parasitaemia of 500–200,000 per micrometer asexual forms;
- Presence of axillary or tympanic temperature greater or equal to 37.5 degrees centigrade or history of fever during the past 24 h;;
- ability to swallow oral medication;
- ability and willingness to comply with the study protocol for the duration of the study and to comply with the study visit schedule;
- informed consent from parent or guardian.
Exclusion Criteria9
- presence of general danger signs in children aged between 6 months and 10 years or signs of severe falciparum malaria according to the definitions of WHO (Appendix 1);
- mRDT negative results
- weight under 5 kg;
- haemoglobin below 8 g per dl;
- mixed or mono-infection with another Plasmodium species detected by microscopy;
- presence of severe malnutrition defined as a child who has symmetrical oedema involving at least the feet or has a mid-upper arm circumference below 110 mm in children greater or equal 59 months; or BMI of below 16 in children aged 5 years and above)
- presence of febrile conditions due to diseases other than malaria (e.g. measles, acute lower respiratory tract infection, severe diarrhoea with dehydration) or other known underlying chronic or severe diseases (e.g. cardiac, renal and hepatic diseases, HIV/AIDS);
- regular medication, which may interfere with antimalarial pharmacokinetics;
- history of hypersensitivity reactions or contraindications to any of the medicine(s) being tested or used as alternative treatment(s);
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Interventions
It is a one arm prospective study to assess the efficacy and safety of artemether-lumefantrine or artesunate-amodiaquine. Artemether-lumefantrine tablets (containing 20 mg artemether+ 120 mg lumefantrine in each tablet) is being given twice daily for three days according to the recommended weight bands as follows: 1 tablet to those weighing 5 to 14 kg; 2 tablets for 15 to 24 kg; 3 tablets for 25 to 34 kg and 4 tablets for equal or greater than 35 kg. The total target dose ranges were 5-24 mg/kg body weight (bw)of artemether and 29-144 mg/kg bw of lumefantrine. Artesunate-amodiaquine is being given a daily dose of approximately artesunate 4 mg/kg and amodiaquine 10mg/kg for 3 consecutive days will be administered. All treatments was given orally under direct supervision by the health worker. The patients were followed up for 28 days. Patients will be sequentially enrolled: first to artemether-lumefantrine until a sample of 88 is reached. Then the subsequent patients will be enrolled to the Artesunate-amodiaquine until the target sample of 88 patients is reached.
Locations(1)
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ACTRN12622001243707