Comparative Biochemical Profiles in Children Treated with Artemether-lumefantrine and Artesunate-amodiaquine for Acute Uncomplicated falciparumMalaria in Jos, North – Central Nigeria.

Abstract

Background: Acute clinical episode of uncomplicated malaria induces several pathophysiological biochemical disturbances in its host. We examined and compared these biochemical alterations in children pre- and post- treatment with ACTs up to day 14 and how the ACTs affect these biochemical parameters during recovery. Aim: To determine and compare the alterations in selected biochemical indices pre- and post-treatment of uncomplicated P. falciparum malaria with artemether-lumefantrine (AL) and artesunate-amodiaquine (AA) in under-five children up toDay 14 day. Method: Data on 111 children aged 6 to 60 months who were enrolled into a drug therapeutic efficacy testing (DTET) of AL (20/120mg) with AA (25mg/67.5mg or 50/135mg) in the treatment of uncomplicated falciparum malaria, were analysed. Inclusion criteria were: history of fever in the last 24hrs and /or measured axillary temperature  37.5oC, P. falciparum infection with parasitaemia> 1000 to < 250,000 parasites/μL, HIV seronegative status, and a written informed consent from parents/ guardians.Enrolees were randomized into one of two treatment arms, and their biochemical indices (ALT, AST, Bilirubin and creatinine) were measured longitudinally on D0, D7 and D14 and analyzed. Results: Of649 subjects screened for parasitaemia , 282 (43.5%) were febrile (temperature  37.5oC),of which 252 (38.8%) had P. falciparumparasitaemia. Parasite counts varied from 1000 - 200,000 asexual forms/μL. The mean age (months) of study population were AL (38.9  16.90)and AA (37.7  16.76) arms respectively, (p= 0.72). Thirty- one (55.4%) and 25 (44.6%) were males and females in the ALstudy arm respectively while 32 (58.2%) and 23 (41.8%) were males and females respectively in the AA study arm, (p=0.77). There were comparable elevations in mean serum levels of AST, ALT,creatinine and total Bilirubin from D0 to peaks by D7 with gradual decline to patients’ normal at D14 post-treatment in AL and AA treatment arms. The difference was not significant. ACTs chemotherapy appeared to have no significant relationship to biochemical disturbances in the study subjects. Conclusions: Uncomplicated paediatric Plasmodium falciparum malaria induces transient alterations in biochemical indices in Jos, North Central Nigeria. Our findings agreed with the literature. Therefore, malaria infection should be considered as a differential diagnosis in febrile children with alterations in selected biochemical indices.