As severe malnutrition is associating with lower exposure to the antimalarial drug lumefantrine in children treated with artemether-lumefantrine; the most common treatment, for uncomplicating falciparum malaria. Children under the age of five are particularly vulnerable; to malaria infection with 61% of all malaria deaths worldwide occurring in this group.
Malnourished children are at an even higher risk of contracting and dying from malaria; with the disease being associated strongly with poverty. The altered physiology in malnourished children may change the uptake and distribution of antimalarial drugs into the body, for example, the absorption and elimination of drugs might be reduced in these children.
Exposure to antimalarial drug
Despite this, there has been little research into how well treatments work in this particular group. Malnourished children and other vulnerable groups of patients, such as pregnant women and very young children, are often excluded in clinical studies as they do not represent the main target group, are difficult to recruit in large numbers, and their participation may raise specific ethical concerns.
However, artemether-lumefantrine, an artemisinin-based combination therapy; is the most common antimalarial treatment using worldwide; and is recommending by the World Health Organization. Lumefantrine exposure; levels of the drug in blood after treatment has been administering; has been reporting to be lower in children comparing to adults.
Dosing regimen as adults
Thus, children are currently prescribing the same dosing regimen as adults; artemether-lumefantrine twice daily for three days. The analysis included data from a clinical trial across two hospitals in Mali and Niger analysing lumefantrine exposure for the treatment of uncomplicated falciparum malaria in 131 children with severe malnutrition; compared to 226 children without malnutrition.
These measures are not routinely collecting in clinical trials of malaria; a practice that should change for a deeper insight into the systematic underexposure of antimalarial drugs in children due to malnutrition. Drug absorption, distribution, metabolism, or elimination might be affected by the nutritional status in children.