Professional Documents
Culture Documents
Source: World Malaria Report 2008. Geneva, World Health Organization, 2008; 2006 data.
Burden of Malaria in Pakistan
Malaria has been a persistent problem in Pakistan. There
were an estimated 1.5 million malaria episodes in 2006
Most cases occur between July and November
About 30% are due to P. falciparum
Chloroquine
Sulphadoxine + Pyrimethamine (SP)
Amodiaquine
South-East Asia has the most drug resistant malaria parasites in the world1,2
2- Kidson,C. et al. (2000). The malaria cauldron of Southeast Asia: conflicting strategies of contiguous
nation states. Parassitologia 42 (1-2) June 101-110
WHO Recommendations for the Clinical diagnosis
In general, settings where the risk of malaria is low, clinical
diagnosis of uncomplicated malaria should be based on:-
(The choice of the ACT should be based on the efficacy of the partner
medicine in the country or area of intended deployment)
1.Lefèvre G, Looareesuwan S, Treeprasertsuk S, et al. A clinical and pharmacokinetic trial of six doses of artemether
lumefantrine for multidrug-resistant Plasmodium falciparum malaria in Thailand. Am J Trop Med Hyg 2001; 64: 247-256
2.van Vugt M, Wilairatana P, Gemperli B, et al. Efficacy of six doses of artemether lumefantrine (benflumetol) in
multidrugresistant Plasmodium falciparum malaria. Am J Trop Med Hyg1999; 60(6): 936-942
Artemisinin Derivatives (ACT’s) Cont……
Artemisinin is a sesquiterpene lactone containing a bridged endoperoxide.
It has:-
Two main lipophilic derivatives, artemether and arteether
A lesser, hydrophilic derivative, artesunate
A major active metabolite in vivo, dihydroartemisinin.
Ref:
1. van Agtmael M, Bouchaud O, Malvy D, et al. The comparative efficacy and tolerability of CGP 56697
(artemether +lumefantrine) versus halofantrine in the treatment of uncomplicated falciparum malaria in
travellers returning from the tropics to The Netherlands and France. Int J Antimicrob Agents 1999; 12: 159-169
2. Kshirsagar NA, Gogtay NJ, Moorthy NS, et al. A randomized, double-blind, parallel-group, comparative
safety, and efficacy trial of oral co-artemether versus oral chloroquine in the treatment of acute uncomplicated
Plasmodium falciparum malaria in adults in India. Am J Trop Med Hyg 2000;62: 402-408
3. van Vugt M, Looareesuwan S, Wilairatana P, et al. Artemether-lumefantrine for the treatment of multidrug-
resistant falciparum malaria. Trans R Soc Trop Med Hyg 2000; 94: 545-548
Indications
Artemether + lumefentrine is indicated for the Treatment
of uncomplicated infections due to P. falciparum or mixed
infections including P. Falciparum in adults and children
Comparator
Comparator
Median percentage parasite reduction at 24 hours was significantly better
(p<0.001) for patients receiving co-artemether than for tested comparators.
Parasite Clearance in Infants and Children
study on infants and small children in sub-Saharan Africa (Kenya, Nigeria
and Tanzania) with the 6-dose regimen of co-artemether demonstrated
that, overall,170/305 (55.7%) of patients achieved clearance within 24
hours, and 302/307 (98.4%) within 48 hours
Prompt Reduction in Fever
Fever clearance in infants and children
In African children, fever clearance (and hence, symptomatic improvement)
occurred significantly faster with co-artemether than with
sulphadoxine+ pyrimethamine (SP) African children with fever >37.5°C
Co-Artemether (n=144)
Sulphadoxine +
pyrimethamine (n=143)
von Seidlein L, Bojang K, Jones P, et al. A randomized controlled trial of artemether / benflumetol, a new
antimalarial and pyrimethamine/sulfadoxine in the treatment of uncomplicated falciparum malaria in African
children. Am J Trop Med Hyg 1998; 58(5): 638-644
Fever Clearance in Adults and Adolescents
Fever clearance times, pooled studies
Comparator
Gametocyte Clearance in Infants and Children
Rapid gametocyte clearance, 6-dose regimen
0-3 days
Day 7
Day 14
Gametocyte Clearance in Adults and Adolescents
Proportion of patients with gametocytes by Day 28, pooled studies
Comparator
Safety & Tolerability
Dosage & Administration
5-14 (< 3) 1 1 1 1 1 1
15-24 (≥ 3–8) 2 2 2 2 2 2
25-34 (≥9 –14) 3 3 3 3 3 3
> 34 ( >1 4) 4 4 4 4 4 4
Dosage & Administration
15-24 (≥ 3–8) 1 1 1 1 1 1
DOSAGE SCHEDULE
BODY DAY 1 DAY 2 DAY3
WEIGHT
5Kg 7 ml 7 ml 7ml
7.5 Kg 10ml 10ml 10ml
10 Kg 14 ml 14 ml 14 ml
15 Kg 20 ml 20 ml 20 ml