| dc.contributor |
Epicentre, Paris, France. francesco.checchi@lshtm.ac.uk |
|
| dc.creator |
Checchi, F |
|
| dc.creator |
Piola, P |
|
| dc.creator |
Fogg, C |
|
| dc.creator |
Bajunirwe, F |
|
| dc.creator |
Biraro, S |
|
| dc.creator |
Grandesso, F |
|
| dc.creator |
Ruzagira, E |
|
| dc.creator |
Babigumira, J |
|
| dc.creator |
Kigozi, I |
|
| dc.creator |
Kiguli, J |
|
| dc.creator |
Kyomuhendo, J |
|
| dc.creator |
Ferradini, L |
|
| dc.creator |
Taylor, W R J |
|
| dc.creator |
Guthmann, J P |
|
| dc.date |
2006 |
|
| dc.date.accessioned |
2017-01-31T07:10:10Z |
|
| dc.date.available |
2017-01-31T07:10:10Z |
|
| dc.identifier |
Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: pharmacokinetic and dosage-related findings from a clinical trial in Uganda. 2006, 5:59 Malar. J. |
|
| dc.identifier |
1475-2875 |
|
| dc.identifier |
16854236 |
|
| dc.identifier |
10.1186/1475-2875-5-59 |
|
| dc.identifier |
http://hdl.handle.net/10144/18902 |
|
| dc.identifier |
http://fieldresearch.msf.org/msf/handle/10144/18902 |
|
| dc.identifier |
Malaria Journal |
|
| dc.identifier.uri |
http://dspace.mediu.edu.my:8181/xmlui/handle/10144/18902 |
|
| dc.description |
BACKGROUND: A six-dose antimalarial regimen of artemether-lumefantrine (A/L) may soon become one of the most widely used drug combination in Africa, despite possible constraints with adherence and poor absorption due to inadequate nutrition, and a lack of pharmacokinetic and effectiveness data. METHODS: Within a trial of supervised versus unsupervised A/L treatment in a stable Ugandan Plasmodium falciparum transmission setting, plasma lumefantrine concentrations were measured in a subset of patients on day 3 (C [lum]day3) and day 7 (C [lum]day7) post-inclusion. Predictors of lumefantrine concentrations were analysed to show how both C [lum]day7 and the weight-adjusted lumefantrine dose affect 28-day recrudescence and re-infection risks. The implications of these novel findings are discussed in terms of the emergence of lumefantrine-resistant strains in Africa. RESULTS: C [lum]day3 and C [lum]day7 distributions among 241 supervised and 238 unsupervised patients were positively skewed. Unsupervised treatment and decreasing weight-adjusted lumefantrine dose were negatively associated with C [lum]day3. Unsupervised treatment and decreasing age showed strong negative associations with C [lum]day7. Both models were poorly predictive (R-squared < 0.25). There were no recrudescences in either arm, but decreasing lumefantrine dose per Kg resulted in up to 13-fold higher adjusted risks of re-infection. Re-infections occurred only among patients with C [lum]day7 below 400 ng/mL (p < 0.001). CONCLUSION: Maintaining the present six-dose regimen and ensuring high adherence and intake are essential to maximize the public health benefits of this valuable drug combination. |
|
| dc.language |
en |
|
| dc.publisher |
BioMed Central |
|
| dc.relation |
http://www.malariajournal.com |
|
| dc.rights |
Archived on this site by Open Access permission |
|
| dc.title |
Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: pharmacokinetic and dosage-related findings from a clinical trial in Uganda. |
|