Vyacheslav Grebenyuk, František Stejskal, Eva Nohýnková, Ivana Zicklerová, Lenka Richterová, Hana Roháčová, Hanuš Rozsypal, Milan Trojánek. Travel Medicine and Infectious Disease, March–April 2023, IF: 12 doi.
MUDr. Vyacheslav Grebenyuk, Department of Infectious Diseases and Travel Medicine, Second Faculty od Medicine and Motol University Hospital
Abstract
Background
The aim of this study was to evaluate the rates of parasitaemia clearance and the prevalence of treatment failure in patients with uncomplicated Plasmodium falciparum malaria treated with artemether-lumefantrine (AL), mefloquine (MQ), and atovaquone-proguanil (AP).
Method
The retrospective descriptive study included adult patients with uncomplicated P. falciparum malaria treated at the University Hospital Bulovka in Prague from 2006 to 2019. Parasitaemia clearance was estimated using a linear regression model.
Results
The study included 72 patients with a median age of 33 years (IQR 27–45) and a male to female ratio of 3.2:1. Thirty-six patients (50.0%) were treated with AL, 27 (37.5%) with MQ and 9 (12.5%) with AP. The proportion of VFR and migrants was 22.2% with no significant differences among the three groups. The median time to the parasitaemia clearance was two days (IQR 2–3) in patients treated with AL versus four days in the MQ (IQR 3–4) and AP (IQR 3–4) groups, p < 0.001. The clearance rate constant was 3.3/hour (IQR 2.5–4.0) for AL, 1.6/hour (IQR 1.3–1.9) for MQ, and 1.9/hour (IQR 1.3–2.4) for AP, p < 0.001. Malaria recrudescence occurred in 5/36 (13.9%) patients treated with AL and in no patients treated with MQ or AP.
Conclusions
The findings demonstrate the superior efficacy of AL compared to other oral antimalarials in early malaria treatment. However, we observed a higher rate of late treatment failure in patients treated with AL than previously reported. This issue warrants further investigation of possible dose adjustments, extended regimens, or alternative artemisinin-based combinations.
