Combination Therapy to Avoid Antimalarial Drug Toxicity

The change in policy guidelines for treating uncomplicated malaria became necessary because the therapeutic efficacy of chloroquine and SP had deteriorated. Hence compliance is a necessity to enable effective check on malaria. This work was carried out to evaluate antimalaria drug prescription and to update its usage in line with WHO guideline on Artemeter Combination therapy in a university based medical center. We utilized descriptive, cross-sectional, retrospective study of antimalaria prescriptions purposely carried out among male and female outpatients with mean age of 22.4±2.8 at a University health facility. This comprised all outpatients prescriptions that contained at least one antimalarial drug filed from October 2018 to September 2019. Systematic sampling was used to select the prescriptions. Based on the total number of 1250 prescriptions containing at least one antimalarial drug, a sampling interval of 5 was calculated and simple balloting was used for the first pick. A total number of two hundred and fifty (250) prescriptions containing at least one antimalarial drug were selected for the study. Out of 250 antimalaria prescriptions, usage of ACT class of Artemeter lumefantrine, Artemeter Amodiaquine and Artemeter Piparaqiune were recorded at 45.6%, 10.4% and 9.6% respectively. Triple combination Artemeter lumefantrine and Sulphadoxine-Pyrimethamine was recorded at 20.4% while Sulphadoxine-Pyrimethamine was recorded at 4%. Combination of antimalarial drugs with antibiotics was recorded at 31.2%. This study showed compliance with National Antimalarial Treatment Guideline for the treatment of malaria infection as it regards the use of artemisinin-based combination therapy. The frequency usage of artemeter lumefantrine was proceeding among other ACTs. The frequency in co-prescription of antibiotics with anti-malaria should be guarded to comply with WHO recommendation.

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In‐Vitro Toxicity Assessment of Antimalarial Drug Toxicity on Cultured Embryonic Rat Neurons, Macrophage (RAW 264.7), and Kidney Cells (VERO‐CCl‐81)

The FASEB Journal ◽

10.1096/fasebj.23.1_supplement.529.3 ◽

2009 ◽

Vol 23 (S1) ◽

Author(s):

Rebecca Latice Agboruche

Keyword(s):

Antimalarial Drug ◽

Drug Toxicity ◽

Toxicity Assessment ◽

In Vitro Toxicity ◽

Raw 264.7 ◽

Kidney Cells ◽

In Vitro Toxicity Assessment

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Evaluation of antimalarial prescription pattern and susceptibility of Plasmodium falciparum isolates in Kaduna, Nigeria

International Journal of Biological and Chemical Sciences ◽

10.4314/ijbcs.v13i7.34 ◽

2020 ◽

Vol 13 (7) ◽

pp. 3398-3410

Author(s):

O. Ifeoluwa Akanni ◽

J.O. Ehinmidu ◽

R.O. Bolaji

Keyword(s):

Plasmodium Falciparum ◽

Combination Therapy ◽

Antimalarial Drug ◽

Drug Prescription ◽

Artemisinin Combination Therapy ◽

Therapy Resistance ◽

Antimalarial Drugs ◽

In Vitro Susceptibility

Nigeria carries the highest burden of malaria in terms of morbidity and mortality. This is compounded by continuous resistance of Plasmodium falciparum to antimalarial drugs. This study was designed to evaluate the profile of malaria patients’ antimalarial drug prescription and in vitro susceptibility of P. falciparum isolates to commonly prescribed antimalarial drugs in Kaduna, Nigeria. Three years’ records of patients antimalarial drug prescriptions were collated (2013 to 2015) and the in vitro antimalarial agent susceptibility was determined for 28 clinical isolates using WHO Mark III microtest. Artemisinin-based combination therapy (ACT) was the most prescribed antimalarial for the period under review (92.3-93.7%). Among the ACTs, Artemether-lumefantrine was most prescribed. Of the 28 P. falciparum isolates evaluated, 3 (10.71%) were resistant to chloroquine with a median IC50 of 4.82μM (4.60-8.14μM), while five (17.86%) were resistant to mefloquine with a median IC50 of 25μM (10.3-41μM), 7(25.00%) to artemether with a median IC50 of 2.69μM (2.09-8.77μM), 9 (32.14%) to artesunate-mefloquine combination with a median IC50 of 9.0μM (7.98-35μM) and to artesunate, 11(39.29%) were resistant with a median IC50 of 2.4μM (1.56-5.65μM). This result shows a decline in resistance of P. falciparum to chloroquine compared to period prior to artemisinin-combination therapy as well as reduced susceptibility to artesunate and artemether. Further in vitro and in vivo monitoring will be required to inform antimalarial drug policy change.Keywords: Antimalarial, Artemisinin-combination therapy, resistance, susceptibility, microtest.

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Antimalarial Drug Toxicity: A Review

Chemotherapy ◽

10.1159/000109767 ◽

2007 ◽

Vol 53 (6) ◽

pp. 385-391 ◽

Cited By ~ 115

Author(s):

Hussien O. AlKadi

Keyword(s):

Antimalarial Drug ◽

Drug Toxicity

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Combination Therapy Strategies for the Treatment of Malaria

Molecules ◽

10.3390/molecules24193601 ◽

2019 ◽

Vol 24 (19) ◽

pp. 3601 ◽

Cited By ~ 15

Author(s):

Sibusiso Alven ◽

Blessing Aderibigbe

Keyword(s):

Combination Therapy ◽

Drug Toxicity ◽

Water Solubility ◽

Therapeutic Agents ◽

Review Article ◽

The Other ◽

Drug Bioavailability ◽

Hybrid Compounds ◽

The World ◽

Therapy Strategies

Malaria is a vector- and blood-borne infection that is responsible for a large number of deaths around the world. Most of the currently used antimalarial therapeutics suffer from drug resistance. The other limitations associated with the currently used antimalarial drugs are poor drug bioavailability, drug toxicity, and poor water solubility. Combination therapy is one of the best approaches that is currently used to treat malaria, whereby two or more therapeutic agents are combined. Different combination therapy strategies are used to overcome the aforementioned limitations. This review article reports two strategies of combination therapy; the incorporation of two or more antimalarials into polymer-based carriers and hybrid compounds designed by hybridization of two antimalarial pharmacophores.

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Rational Risk-Benefit Decision-Making in the Setting of Military Mefloquine Policy

Journal of Parasitology Research ◽

10.1155/2015/260106 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Remington L. Nevin

Keyword(s):

Decision Making ◽

Antimalarial Drug ◽

Drug Toxicity ◽

Neuropsychiatric Symptoms ◽

High Rate ◽

Current Evidence ◽

Neurological Sequelae ◽

Us Military ◽

The Us ◽

Continued Use

Mefloquine is an antimalarial drug that has been commonly used in military settings since its development by the US military in the late 1980s. Owing to the drug’s neuropsychiatric contraindications and its high rate of inducing neuropsychiatric symptoms, which are contraindications to the drug’s continued use, the routine prescribing of mefloquine in military settings may be problematic. Due to these considerations and to recent concerns of chronic and potentially permanent psychiatric and neurological sequelae arising from drug toxicity, military prescribing of mefloquine has recently decreased. In settings where mefloquine remains available, policies governing prescribing should reflect risk-benefit decision-making informed by the drug’s perceived benefits and by consideration both of the risks identified in the drug’s labeling and of specific military risks associated with its use. In this review, these risks are identified and recommendations are made for the rational prescribing of the drug in light of current evidence.

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