Sasha Biggers

November 2013
Biology 1615
Wednesday 10:00 am

Successful Treatment of Plasmodium Falciparum Malaria with a Six-Dose Regimen of
Artemether-Lumefantrine Vs. Quinine-Doxycycline in Western Amazon Region of Brazil

Introduction: Malaria is a persistent, parasite-borne, flu-like illness plaguing many parts
of the world, particularly underdeveloped, third-world countries. There are multiple methods of
prevention and treatment, but despite these, malaria infects hundreds of millions of people each
year. In the year 2010, 219 million cases of malaria occurred, resulting in 660,000 deaths.
(www.cdc.gov/malaria/)
Reason for research: Persistence of the disease is largely due to insecticide-resistant
strains of the parasite. This article presents a study of the chloroquine-resistant malaria parasite,
Plasmodium Falciparum, and its response to treatment with quinine-doxycycline versus
artemether-lumefantrine. Quinine-doxycycline is the first line treatment for P Falciparum with a
cure rate of 77%. The artemether-lumefantrine combination provides a higher rate of
antimalarial efficacy than when the individual components are used as mono-therapy. The
objective of the study was to compare the efficacy and safety of artemether-lumefantin against
quinine-doxycycline in the treatment of P Falciparum malaria in the Western Amazon region of
Brazil.
Methods and materials: The study consisted of a group of 59 malaria-infected patients:
31 in the quinine-doxycycline group and 28 in the artemether-lumefantrine group. The study
population consisted of males and females over the age of 16 with a diagnosis of P Falciparum
malaria. Patients with vomiting, diarrhea, or inability to take food by mouth were excluded.
Also excluded were patients with previous use of antimalarial medication for the present
infection or current use of antibiotics, antiarrhythmics, or cardiotonic drugs. No pregnant or
breast-feeding patients were allowed in the study.
The treatment dose for the artemether-lumefantrine combination group was 20 mg and
120 mg, respectively. Four tablets were given for the first dose, 4 tablets 8 hours later, then 4
tablets every 12 hours for the next 2 days. The dose for quinine-doxycycline was 500 mg and
100 mg, respectively. One tablet of quinine was given every 8 hours for 3 days, and 1 tablet of
doxycycline every 12 hours for 5 days.
All patients were hospitalized during the entire course of treatment, assessed daily via
physical examination, medical history, thick blood smear, and quantitative buffy coat (QBC) test.
Lab tests were done at the beginning of the study as a baseline, then on day 6 following
treatment. Electrocardiogram (ECG) tests were performed at baseline and on days 2 and 6.
Results: There were 3 patients who did not complete the study. One withdrew consent
due to personal problems, and two withdrew due to adverse effects of the treatment (vomiting).
The percentage of infected patients in the quinine-doxycycline group was 48.8% on day 3, 7.5%
on day 4, and there were no infected patients on day 6. The percentage of infected patients in the
artemether-lumefantrine group decreased 17.9% by day 2, with no infected patients by day 3.
Discussion: The percentage of patients infected with P Falciparum, confirmed via
positive QBC test, was decreased more rapidly with artemether-lumefantrine than with quinine-
doxycycline. All patients treated in the study were parasite free upon completion of the study,
but the artemether-lumefantrine group was cleared of parasitemia within 3 days, compared with
only 50% of patients in the quinine-doxycycline group being parasite free by day 3.
The majority of adverse events during the study were mild in severity. Common
complaints included fatigue, arrhythmia, myalgia, palpitations, sleep disorders, and cough, which
are symptoms consistent with malaria. Study conductors admit difficulty in determining
symptoms of malaria vs. medication side-effects.
Many commonly used antimalarial agents are associated with potentially serious cardiac
side-effects. Although there were abnormal ECG results for 18.5% of patients in the artemether-
lumefantrine group and 13.8% in the quinine-doxycycline group, scientists declared there was no
clinically significant evidence of cardiotoxicity from the treatment in this study.
The simplicity of drug administration associated with artemether-lumefantrine, including
shorter duration, leads to higher patient compliance than with quinine-doxycycline. Artemether-
lumefantrine is also favorable due to its more rapid and efficacious antimalarial activity.


Sources Cited

Article: SUCCESSFUL TREATMENT OF PLASMODIUM FALCIPARUM MALARIA WITH
A SIX-DOSE REGIMEN OF ARTEMETHER-LUMEFANTRIN VERSUS QUININE-
DOXYCYCLINE IN THE WESTERN AMAZON REGION OF BRAZIL; American Journal of
Tropical Medicine and Hygeine, January 2006, vol 74 no 1 page 20-25
http://www.ajtmh.org/content/74/1/20.full?sid=049bbd2d-82ac-4b2c-b995-e92111618802
http://www.cdc.gov/malaria/