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Artemether-Lumefantrine Compared to Atovaquone-Proguanil as a Treatment for Uncomplicated Plasmodium falciparum Malaria in Travelers

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  • The Center of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Atovaquone-proguanil (AP) and artemether-lumefantrine (AL) are both treatments for uncomplicated Plasmodium falciparum malaria, but comparative clinical trials are lacking. We performed a retrospective analysis, comparing treatment failure and fever clearance time in non-immune travelers with uncomplicated P. falciparum malaria, treated with AP or AL. Sixty-nine patients were included during 2001–2013: 44 in the AP group and 25 in the AL group. Treatment failure was observed in 6 of 44 (13.6%) and 1 of 25 (4.0%) patients in the AP and AL groups, respectively. Six treatment failures were observed in travelers from West Africa. Fever clearance time was 44 ± 23 h in AL group versus 77 ± 28 h in AP group, (P < 0.001). Hospitalization time was significantly shorter in the AL group; 3.8 + 1.3 versus 5.1 + 2.8 days in the AP group (P = 0.04) In conclusion, travelers with uncomplicated P. falciparum malaria recover faster on AL than on AP. The AL should probably be the drug of choice for this population.

Author Notes

* Address correspondence to Eli Schwartz, The Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: elischwa@post.tau.ac.il

Disclosure: This study was performed in partial fulfillment of the M.D. thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.

Authors' addresses: Shirly Grynberg, The Chaim Sheba Medical Center, The Center for Geographic MedicineTel Hashomer, Israel, Tel Aviv University, and The Sackler Faculty of Medicine, Tel Aviv, Israel, E-mail: shirlygrynberg@gmail.com. Tamar Lachish, Shaare-Zedek Medical Center, The Infectious Diseases Unit, Jerusalem, Israel, E-mail: lachisht@yahoo.com. Eran Kopel, The Chaim Sheba Medical Center, The Center for Geographic Medicine, Tel Hashomer, Israel, E-mail: eran.kopel@mail.huji.ac.il. Eyal Meltzer, The Chaim Sheba Medical Center, The Center for Geographic Medicine and Department of Medicine C, Tel Hashomer, Israel, and Tel Aviv University, The Sackler Faculty of Medicine, Tel Aviv, Israel, E-mail: emeltzer@post.tau.ac.il. Eli Schwartz, The Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer, Israel, E-mail: elischwa@post.tau.ac.il.

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