Background Malaria is a life-threatening disease caused by plasmodium falciparum transmitted through anopheles mosquitoes. Treatment is based on artemisinin derivatives. Clinical data reported by the World Health Organisation (WHO) shows a 92% mortality in Africa. According to WHO, first-line treatment of uncomplicated falciparum malaria for patients from Africa is artemisinin-based therapy. Resistance to artemisinin-based therapy in Africa is based on case reports. Clinical trials of piperaquine/dihydroartemisinin performed in Asia and Africa show 97% and 92.7% efficacy, respectively.
Purpose Evaluate effectiveness of artemisinin derivatives.
Evaluate safety of artemisinin derivatives.
Material and methods Retrospective, observational study in regional hospital. Parasitemia and side-effects’evaluation of all patients diagnosed with malaria from July 2016 to July 2017, treated with piperaquine/dihydroartemisinin and/or artesunate. Data obtained from ARIADNA Clinical Station®. Artesunate treatment based on seriousness criteria (parasitaemia greater than 4%, convulsions, shock, spontaneous bleeding, bilirubin greater than 2.5 mg/dL, severe hypoglycaemia, severe normocytic anaemia, haemoglobinuria and hyperlactacidaemia).
Results Fifty-four patients included, age: 36 years (15–60). All patients treated with piperaquine/dihydroartemisinin, 11 treated previously with intravenous artesunate.
Parasitaemia: 8.61% (0%–37.5%). Time controls: 24 hours (23 patients, 42.29%), 48 hours (25 patients, 46.29%), 72 hours (three patients, 5.56%) 96 hours (one patient, 1.85%), 120 hours (one patient, 1.85%) and 144 hours (one patient, 1.85%). Ninepatients required artesunate due to serious parasitaemia and two to bilirubin over 3.9 mg/dL. Parasitaemia: 10.25% (4%–37.5%, excluding seriousness criteria). 2.45% after two doses of artesunate at 2.4 mg/kg. Only one patient (HIV diagnosed) over 2% after 48 hours and three doses. One patient died 1 month later due to HIV complications with no parasitaemia.
Mean hospitalisation stay: 2.31 days/patient (3.72 days/patient in artesunate subgroup), no readmission due to recurrence of malaria.
Safety: only eight patients showed treatment’s side-effects, (anaemia, pyrexia, hypertransaminaemia, thrombopaenia, abdominal pain, superficial mycosis and perioral and ocular herpes).
Conclusion Artemisinin derivatives are highly effective and moderately safe in malarian patients. Artesunate should be reserved for severe cases to increase its efficiency. No resistance to artemisinin-based therapy was observed.
No conflict of interest
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