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Adherence and efficacy of supervised versus non-supervised treatment with artemether/lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Bangladesh: a randomised controlled trial.
- Source :
-
Transactions of the Royal Society of Tropical Medicine and Hygiene [Trans R Soc Trop Med Hyg] 2008 Sep; Vol. 102 (9), pp. 861-7. Date of Electronic Publication: 2008 Jul 07. - Publication Year :
- 2008
-
Abstract
- As artemether/lumefantrine is now deployed as the first-line treatment for uncomplicated falciparum malaria in Bangladesh, information on its efficacy and adherence to its use is important. A randomised controlled non-inferiority trial comparing directly observed treatment (DOT) and non-directly observed treatment (NDOT) was conducted in 320 patients with uncomplicated falciparum malaria in Bandarban Hill Tract District, Bangladesh. Both regimens showed similar high levels of PCR-corrected 42-day parasitological and clinical cure rates (99.3% in the NDOT group and 100% in the DOT group; P=0.49). Survival analysis for the time to recurrence of infection showed no difference between treatment groups (log rank, P=0.98). Adherence, as assessed by counting remaining tablets and oral interviews, was 93% in the NDOT group and was confirmed by Day 7 lumefantrine concentrations. Adherence was independent of educational level. Patients with plasma lumefantrine concentrations < 280 ng/ml at Day 7 were at greater risk for re-infection (relative risk 5.62; P=0.027). The efficacy of artemether/lumefantrine for the treatment of uncomplicated falciparum malaria in Bangladesh is high and is similar for DOT and NDOT. Adherence to therapy is high.
- Subjects :
- Adolescent
Adult
Animals
Antimalarials blood
Artemether
Artemisinins blood
Child
Child, Preschool
Drug Combinations
Ethanolamines blood
Female
Fluorenes blood
Humans
Lumefantrine
Male
Middle Aged
Plasmodium falciparum isolation & purification
Polymerase Chain Reaction
Treatment Outcome
Antimalarials therapeutic use
Artemisinins therapeutic use
Directly Observed Therapy
Ethanolamines therapeutic use
Fluorenes therapeutic use
Malaria, Falciparum drug therapy
Medication Adherence
Subjects
Details
- Language :
- English
- ISSN :
- 0035-9203
- Volume :
- 102
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Transactions of the Royal Society of Tropical Medicine and Hygiene
- Publication Type :
- Academic Journal
- Accession number :
- 18606428
- Full Text :
- https://doi.org/10.1016/j.trstmh.2008.05.022