Artemether + lumefantrine: new drug. An alternative to atovaquone + proguanil

(1) Treatment of uncomplicated malaria acquired in areas of chloroquine resistance is based on oral drugs chosen according to local resistance patterns. The atovaquone + proguanil combination is often the first choice for travelers because of its tolerability and convenience. (2) For the treatment of uncomplicated malaria, artemisinin derivatives, extracted from a Chinese plant, have a short-lived action and should not therefore be used as monotherapy. (3) Only one combination of this type, artemether plus lumefantrine (an antimalarial related to halofantrine), is marketed in France for the treatment of uncomplicated malaria. (4) In African trials, the efficacy of the artemether + lumefantrine combination, taken in 6 doses over 3 days, was fairly consistent and similar (or even superior) to that of the amodiaquine + sulfadoxine + pyrimethamine combination in three trials. It was more effective than the quinine + doxycycline combination in a region of Brazil where strains with diminished sensitivity to quinine circulate. (5) Artemether has the adverse effects of all artemisinin derivatives, especially gastrointestinal and neurological disorders. Lumefantrine, a drug related to halofantrine, prolongs the QT interval (albeit less than halofantrine), and this sometimes warrants ECG monitoring and blood potassium assays, especially in patients who have hepatic or renal failure or who are taking other drugs that affect the QT interval. (6) The absorption of lumefantrine is dependent on the presence of food in the stomach, which can be difficult as loss of appetite and nausea are frequent during malaria attacks. Intake of about 1.5 g of fat seems sufficient for satisfactory absorption. The artemether + lumefantrine combination is effective in case of resistance to other antimalarials. It is an alternative to the atovaquone + proguanil combination for travelers.