For some years WHO has been pushing on African Countries to change the first line treatment for uncomplicated malaria, because of increasing evidence of SP (sulphadoxine-pirimetamine= fansidar, metakelfin) resistance
A first line treatment is considered ineffective when the percentage of resistance in the general population is about 25-30%
Studies conducted in Kenya have shown a percentage of SP resistance around 35%.
Therefore WHO has encouraged the health authorities to switch to an Artemisin based compound
Artemisin drugs are very good because of very quick action, but they are very short lived and therefore they are exposed to the risk of early resistance if not associated with a long acting compound which remains in the body for longer time
This is the reason of combination drugs, which seem to reduce the likelihood of drug resistance.
Coartem, the drug chosen in Kenya, contains artemether and lumefantrine
Other Countries have chosen different schemes: Uganda has decided on another fixed combination in which artemisin compounds are associated with amodiaquin
Coartem can be prescribed for uncomplicated malaria.
It has not been tested for cerebral malaria and pulmonary oedema 20 to malaria.
Coartem is a fixed combination of Artemether (an Artemisin derivative) and Lumefantrin.
Artemether is very quick acting and short lived.
Lumefantrine is long acting: the combination assures a low degree of resistance.
INDICATIONS
Uncomplicated malaria where Plasmodium Falciparum is postulated.
Not for complicated malaria.
Not as prophylaxis.
CONTRAINDICATIONS
• Patient with severe malaria according to WHO.
• First trimester of pregnancy.
• Breast feeding.
• Patients with heart problems.
• Patients with Potassium imbalance.
• Severe hepatic of renal failure
• Patient on treatment with:
(1) amitriptiline or other anti depressants
(2) Anti-arrhythmic drugs.
(3) Neuroleptics.
(4) Some antibiotics like macrolides (Erythromycin, etc), Flourquinolones (Noroxin, Ciproxin, etc), Antifungals.
CAUTIONS!
Using quinine and coartem very near to one another poses an increased risk of heart arrhythmia.
So when that is necessary, close monitoring with ECG must be done
PREGNANCY
Absolute contraindication in 1st trimester (risk of abortion, teratogenicity).
In 2nd and 3rd trimester to be given only when benefits to the mother overwhelm potential risks to fetus.
LACTATION
Coartem should not be taken.
USE OF MACHINES
Effects on driving and use of machines:
(a) Dizziness and weakness of the body are common.
So patients should be advised NOT to drive and NOT to use machines.
SIDE-EFFECTS
Headache,
Insomnia,
Palpitations,
Cough,
Abdominal pains,
Anorexia,
Nausea & vomiting,
Diarrhoea,
Itching of the body,
Fatigue.
PHARMACODYNAMICS
Active on trophozoites, schizonts and gametocytes.
Not active on hypnozoites.
ABSOPTION AND ELIMINATION
Absorption is much better on full stomach.
It is very quick for Artemether, it is slower for Lumefantrine.
Artemether is cleared from the body in about 2 hours.
Lumefantrine has half life of 2-3 days.
DOSAGE
ADULTS: 4 tabs BD for 3 days.
CHILDREN: 5-15 kg 1 tab BD 3 days.
CHILDREN: 15-25 kg 2 tabs BD 3 days.
CHILDREN: 25-35 kg 3 tabs BD 3 days.
Fr Beppe
A first line treatment is considered ineffective when the percentage of resistance in the general population is about 25-30%
Studies conducted in Kenya have shown a percentage of SP resistance around 35%.
Therefore WHO has encouraged the health authorities to switch to an Artemisin based compound
Artemisin drugs are very good because of very quick action, but they are very short lived and therefore they are exposed to the risk of early resistance if not associated with a long acting compound which remains in the body for longer time
This is the reason of combination drugs, which seem to reduce the likelihood of drug resistance.
Coartem, the drug chosen in Kenya, contains artemether and lumefantrine
Other Countries have chosen different schemes: Uganda has decided on another fixed combination in which artemisin compounds are associated with amodiaquin
Coartem can be prescribed for uncomplicated malaria.
It has not been tested for cerebral malaria and pulmonary oedema 20 to malaria.
Coartem is a fixed combination of Artemether (an Artemisin derivative) and Lumefantrin.
Artemether is very quick acting and short lived.
Lumefantrine is long acting: the combination assures a low degree of resistance.
INDICATIONS
Uncomplicated malaria where Plasmodium Falciparum is postulated.
Not for complicated malaria.
Not as prophylaxis.
CONTRAINDICATIONS
• Patient with severe malaria according to WHO.
• First trimester of pregnancy.
• Breast feeding.
• Patients with heart problems.
• Patients with Potassium imbalance.
• Severe hepatic of renal failure
• Patient on treatment with:
(1) amitriptiline or other anti depressants
(2) Anti-arrhythmic drugs.
(3) Neuroleptics.
(4) Some antibiotics like macrolides (Erythromycin, etc), Flourquinolones (Noroxin, Ciproxin, etc), Antifungals.
CAUTIONS!
Using quinine and coartem very near to one another poses an increased risk of heart arrhythmia.
So when that is necessary, close monitoring with ECG must be done
PREGNANCY
Absolute contraindication in 1st trimester (risk of abortion, teratogenicity).
In 2nd and 3rd trimester to be given only when benefits to the mother overwhelm potential risks to fetus.
LACTATION
Coartem should not be taken.
USE OF MACHINES
Effects on driving and use of machines:
(a) Dizziness and weakness of the body are common.
So patients should be advised NOT to drive and NOT to use machines.
SIDE-EFFECTS
Headache,
Insomnia,
Palpitations,
Cough,
Abdominal pains,
Anorexia,
Nausea & vomiting,
Diarrhoea,
Itching of the body,
Fatigue.
PHARMACODYNAMICS
Active on trophozoites, schizonts and gametocytes.
Not active on hypnozoites.
ABSOPTION AND ELIMINATION
Absorption is much better on full stomach.
It is very quick for Artemether, it is slower for Lumefantrine.
Artemether is cleared from the body in about 2 hours.
Lumefantrine has half life of 2-3 days.
DOSAGE
ADULTS: 4 tabs BD for 3 days.
CHILDREN: 5-15 kg 1 tab BD 3 days.
CHILDREN: 15-25 kg 2 tabs BD 3 days.
CHILDREN: 25-35 kg 3 tabs BD 3 days.
Fr Beppe
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