The online version of this article (doi:10.1186/1475-2875-11-413) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
ENE and MMM contributed to design of the study; FO, CO and MMM coordinated the study, performed data analysis and drafted the paper; EE, FO and EE performed clinical assessment; CO, OO and VA performed laboratory tests, AA supervised laboratory team, EBE contributed to data analysis and drafting of paper. All authors read and approved the final manuscript.
The use of anti-malarial drug combinations with artemisinin, or with one of its derivatives, is now widely recommended to overcome drug resistance in falciparum malaria. Fixed-dose combination of artemisinin and naphthoquine is a new generation artemisinin combination therapy (ACT) offered as a single dose therapy. The aim of the study was to assess the therapeutic efficacy, safety and tolerability of three dosage schedules of fixed-dose combination of artemisinin (125 mg) and naphthoquine (50 mg) for treating uncomplicated Plasmodium falciparum malaria among adolescents and adults in Calabar, South-east Nigeria.
A total of 121 patients aged ≥15 years with uncomplicated P. falciparum malaria were enrolled and randomly assigned to three dosage schedules: (A) 700 mg (four tablets) single dose; (B) 700 mg 12-hourly x two doses; and (C) 1,400 mg (eight tablets) single dose. Patients were observed for 28 days, with clinical, parasitological, and haematological assessments.
A total of 108 patients completed the study. The overall 28-day cure rate was 88.9%. Day 28-cure rates of the three dosage schedules were 85.3%, 93.1% and 88.9% for Group A, B and C respectively. Adverse events were few and mild, the commonest being weakness and headache; there was no serious adverse event.
Concerns for emergence of parasite resistance due to the use of artemisinin-naphthoquine as single dose regimen is likely to compromise the usefulness of this potentially important combination treatment. A robust multi-centre trial is recommended to evaluate a three-day regimen with potentials to achieve high cure rates while minimizing the risk of emergence of resistant parasite strains.
Federal Ministry of Health: 2005 Annual report. National malaria control programme. 2005, Abuja, Nigeria: Federal Ministry of Health
Ezedinachi ENU, Ejezie GC, Usanga EA, Gemade EII, Ikpatt NW, Alaribe AAA: New trends in chloroquine efficacy in the treatment of malaria: chloroquine resistant plasmodium falciparum in anambra and Benue states of Nigeria. Cent Afr J Med. 1991, 37: 180-186. PubMed
Ezedinachi ENU, Ekanem OJ: Efficacy of antimalarials in a population study; efficacy and tolerability of a low-dose mefloquine-sulfadoxine-pyrimethamine combination. AmJTrop Med Hyg. 1999, 61: 114-119.
Federal Ministry of Health: Federal Republic of Nigeria National Antimalarial Treatment policy. 2005, Abuja-Nigeria: National Malaria And Vector Control Division
World Health Organization: Report of a WHO technical consultation. Antimalarial drug combination therapy. 2001, Geneva: WHO, WHO/CDS/RBM/2001.35
Watkins WM, Sibley CP, Hastings IM: The search for effective and sustainable treatments for plasmodium falciparum malaria in Africa: a model of the selection of resistance by antifolate drugs and their combinations. AmJTrop Med Hyg. 2005, 72: 163-173.
Wang SQ, Meng F, Shen H, Wen Y, Zhuo KR, Zhu QX, Pang XJ, Lin SG, Zeng LH: Therapeutic effect of dihydroartemisinin combined with naphthoquine phosphate in patients with falciparum malaria. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2002, 20: 180-182. PubMed
Wang JY, Shan CQ, Fu DD, Sun ZW, Ding DB: Efficacy of naphthoquine, artemisinin and a combination of the two drugs in the treatment of falciparum malaria. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2003, 21: 131-133. PubMed
World Health Organization: Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. 2003, Geneva: World Health Organization, 1-62. WHO/HTM/RBM/2003.50
World Health Organization: Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000, 94 (Suppl. 1): 1-90. CrossRef
Shute GT: The microscopic diagnosis of malaria. Principle and practice of malariology. Edited by: Wernsdorfer W, McGregor IA. 1988, Edinburgh: Churchill Livingstone, 781-814.
Hombhanje FW, Linge D, Saweri A, Kuanch C, Jones R, Toraso S, Geita J, Masta A, Kevau I, Hiawalyera G, Sapuri M: Artemisinin-naphthoquine combination (ARCO™) therapy for uncomplicated falciparum malaria in adults of Papua New guinea: a preliminary report on safety and efficacy. Malar J. 2009, 8: 196-10.1186/1475-2875-8-196. PubMedCentralCrossRefPubMed
Toure OA, Penali LK, Yapi J, Ako BA, Toure W, Djerea K, Gomez GO, Makaila OA: Comparative, randomized clinical trial of artemisinin/napthoquine twice daily one day versus artemether/lumefantrine six doses regimen in children and adults with uncomplicated falciparum malaria in cote d’Ivoire. Malar J. 2009, 8: 148-10.1186/1475-2875-8-148. PubMedCentralCrossRefPubMed
Meremikwu M, Alaribe AAA, Ejemot R, Oyo-Ita A, Ekenjoku J, Nwachukwu C, Ordu D, Ezedinachi ENU: Artemether-lumefantrine versus artesunate plus amodiaquine for treating uncomplicated childhood malaria in Nigeria: randomized controlled trial. Malar J. 2006, 5: 43-10.1186/1475-2875-5-43. PubMedCentralCrossRefPubMed
Krudsood S, Chaleemurt K, Pengruksa C, Srivilairit S, Silachamroon U, Treeprasertsuuk S, Brittenham GM, Looareesuwan S: Comparative clinical trial of two-fixed combinations dihydroartemisinin-naphthoquine-trimethoprim (DNP) and artemether-lumefantrine (coartem/riamet) in the treatment of acute uncomplicated falciparum malaria in Thailand. S E Asian J Trop Med Public Health. 2003, 34: 316-321.
Hutagalung R, Piphun L, Ashley EA, McGready R, Brockman A, Thwait KL, Singhasivanon P, Jelinek T, White NJ, Nosten FH: A randomized trial of artemether-lumefantrine versus mefloquine-artesunate for the treatment of uncomplicated multi-drug resistant plasmodium falciparum on the western border of Thailand. Malar J. 2005, 4: 46-10.1186/1475-2875-4-46. PubMedCentralCrossRefPubMed
Gbotosho GO, Sowunmi A, Happi CT, Okuboyejo TM: Therapeutic efficacies of artemisinin-based combination therapies in Nigerian children with uncomplicated falciparum malaria during five years of adoption as first-line treatments. AmJTrop Med Hyg. 2011, 84: 936-943. 10.4269/ajtmh.2011.10-0722. CrossRef
- Open-label trial of three dosage regimens of fixed-dose combination of artemisinin and naphthoquine for treating uncomplicated falciparum malaria in calabar, Nigeria
Martin M Meremikwu
Ekpereonne B Esu
Emmanuel N Ezedinachi
- BioMed Central
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