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Treatment with Coartem (Artemether-Lumefantrine) in Papua New Guinea

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  • 1 Swiss Tropical Institute, Basel, Switzerland; Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province, Papua New Guinea; Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
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A recent drug efficacy trial reported Coartem (artemether-lumefantrine) to be highly effective against Plasmodium falciparum in children less than 5 years of age in Papua New Guinea (PNG). In contrast, we have observed high levels of treatment failures in non-trial conditions in a longitudinal cohort study in the same age group in PNG. Recrudescences were confirmed by genotyping of three different marker genes to provide optimal discrimination power between parasite clones. After excluding genetic host factors by genotyping potentially relevant cytochrome P450 loci, the high number of treatment failures in our study is best explained by poor adherence to complex dosing regimens in combination with insufficient fat supplementation, which are both crucial parameters for the outcome of Coartem treatment. In contrast to the situation in classic drug trials with ideal treatment conditions, our field survey highlights potential problems with unsupervised usage of Coartem in routine clinical practice and under program conditions.

Author Notes

*Address correspondence to Ingrid Felger, Swiss Tropical Institute, Socinstr. 57, 4002-Basel, Switzerland. E-mail: ingrid.felger@unibas.ch

Financial support: The study was supported by the Swiss National Science Foundation (grant no: 31003A-112196) and the National Institute of Health. S. Schoepflin was supported by the Forlen Foundation.

Authors' addresses: Sonja Schoepflin and Ingrid Felger, Swiss Tropical Institute, Basel, Switzerland, E-mail: engrid.felger@unibas.ch. Enmoore Lin, Benson Kiniboro, and Ivo Mueller, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province 441, Papua New Guinea. Jeana T. DaRe, Rajeev K. Mehlotra, and Peter A. Zimmerman, Center for Global Health and Diseases, Case Western Reserve University, Wolstein Research Building, Cleveland, OH.

Reprint requests: Ingrid Felger, Swiss Tropical Institute, Socinstr. 57, 4002-Basel, Switzerland, Tel: +41-61-2848-117, Fax: +41-61-2848-101, E-mail: ingrid.felger@unibas.ch.

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