A RANDOMIZED CLINICAL TRIAL COMPARING ARTESUNATE/AMODIAQUINE AND COARTEM IN TREATMENT OF UNCOMPLICATED MALARIA IN PREGNANCY IN MULAGO HOSPITAL.

  • Charles Lukanga Kimera Lecturer in department of Obstetrics and Gynaecology, School of Medicine, University of Namibia.

Abstract

BACKGROUND: The therapeutic efficacy and safety of artesunate plus amodiaquine and artemether/lumefantrine were assessed in Mulago hospital, Kampala, Uganda, an area with high levels of Plasmodium falciparum resistance to chloroquine and sulphadoxine-pyrimethamine.

MATERIALS AND METHODS: A total of 369 pregnant mothers beyond the first trimester (>12 weeks) and less than 37 weeks of gestation with signs and symptoms of malaria were screened for malaria parasites. Of these, 109 had uncomplicated malaria infection with parasite density 200 to 200,000 parasites/μL and were enrolled following informed consent. Eligible pregnant mothers were randomly assigned to receive either a 3-day course of Coartem (Artemether 20mgs/ Lumefantrine 200mgs) 4 tablets twice a day 12 hourly on days 0, 1 and 2; or Artesunate/Amodiaquine on days 0, 1 and 2 (4tablets of Artesunate plus 4 tablets of Amodiaquine once a day). The Coartem arm had 55 participants while the Artesunat/Amodiaquine (DUACT) arm had 54 participants. Patients were followed up with clinical and laboratory assessments until day 14.

RESULTS: The clinical and parasitological response between Coarten (artemether-lumefantrine) and artesunate+amodiaquine (DUACT) in the treatment of uncomplicated malaria in pregnant mothers were statistically similar. The side effects for the two treatment arms were also statistically similar.

CONCLUSION: Artemether-lumenfantrine (coartem) and artesunate plus amodiaquine (DUACT) had high and similar cure rates and tolerability among pregnant mothers in Mulago Hospital, Uganda.

References

WHO world malaria report 2018
WHO malaria treatment guidelines 2015
Africa Malaria Report, 2003 – The World Health Organisation
Steketee RW, Nahlen BL, Parise ME, Menedez C. The burden of malaria in pregnancy in malaria-endemic areas. American journal of tropical medicine and hygiene 2001; 64(1, 2) S: 28-35.
Centre for Disease Control and Prevention (CDC)
Menendez C1, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E, Font F, Alonso PL: The impact of placental malaria on gestational age and birth weight.
Malaria Prev. new - Regional Office for Africa - World Health ... https://www.afro.who.int/sites/default/files/2017.../malaria_in_pregnancy_092004
Richard W. Steketee, Bernard L. Nahlen, Monica E. Parise, and Clara Menendez: The Burden of Malaria in Pregnancy in Malaria-Endemic Areas
Tanzania Health Research Bulletin (2007), Vol. 9, No. 3: Placental malaria in Owerri, Imo State, south-eastern Nigeria
Effect of pregnancy on exposure to malaria mosquitoes. – NCBI - S Lindsay - ‎2000
WHO | Intermittent preventive treatment in pregnancy (IPTp) https://www.who.int/malaria/areas/preventive_therapies/pregnancy/en/
Malaria Treatment and Management: https:emedicine.mediscape.com
Centres for Disease Control and Prevention. Updated CDC Recommendations for Using Artemether-Lumefantrine for the Treatment of Uncomplicated Malaria in Pregnant Women in the United States; https://www.cdc.gov/mmwr/volumes/67/wr/mm6714a4.htm?s_cid=mm6714a4_e#contribAff. April 2018; Accessed: April 13, 2018.)
Wernsdorfer, McGregor L. Edinburgh: Churchhill Livingstone; 1988:781- 814. Shute GT: The microscopic diagnosis of malaria. In Principle and practice of malariology
Steketee RW et al. the problem of malaria and malaria control in pregnancy in sub-Saharan Africa. American journal of tropical medicine and hygien, 1996, 55 (1 suppl), 2-7.
McGready R, Cho, T, Keo, NK, et al. Artemisinin antimalarials in pregnancy: a prospective treatment study of 539 episodes of Multidrug-resistant Plasmodium falciparum. Clin Infect Dis 2001;33:2009.
Published
2019-02-23
How to Cite
Kimera, C. L. (2019). A RANDOMIZED CLINICAL TRIAL COMPARING ARTESUNATE/AMODIAQUINE AND COARTEM IN TREATMENT OF UNCOMPLICATED MALARIA IN PREGNANCY IN MULAGO HOSPITAL. Journal of Advance Research in Medical & Health Science (ISSN: 2208-2425), 5(2), 01-13. Retrieved from https://jiaats.com/ojs31/index.php/mhs/article/view/956