Prospective evaluation of artemether-lumefantrine for the treatment of non-falciparum and mixed-species malaria in Gabon

Ghyslain Mombo-Ngoma, Christian Kleine, Arti Basra, Heike Würbel, Daisy A Diop, Mesküre Capan, Ayola A Adegnika, Florian Kurth, Benjamin Mordmüller, Fanny Joanny, Peter G Kremsner, Michael Ramharter, Sabine Bélard, Ghyslain Mombo-Ngoma, Christian Kleine, Arti Basra, Heike Würbel, Daisy A Diop, Mesküre Capan, Ayola A Adegnika, Florian Kurth, Benjamin Mordmüller, Fanny Joanny, Peter G Kremsner, Michael Ramharter, Sabine Bélard

Abstract

Background: The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence.

Methods: This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon.

Results: Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n=38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study.

Conclusions: This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon.

Trial registration: ClinicalTrials.gov Identifier: NCT00725777.

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