Recurrence of Falciparum Malaria under Coartem Treatment in the City of Mâncio Lima, Acre, Brazil: A Retrospective Study

Background: Malaria remains a health problem in the Amazon and since 2005 the state of Acre has high incidence of malaria. Treatment with Coartem® for cases of falciparum malaria was introduced in Acre in August 2012. In Brazil, there is still no published study on the effectiveness of Coartem in endemic areas.

Methods: This study was conducted in Mâncio Lima, Acre, in the western Brazilian Amazon region. All malaria cases notified in Mâncio Lima between August 01st, 2012 and October 31st, 2013 were revised. The therapeutic response to Coartem in Mâncio Lima, Acre, was evaluated. A recurrence of falciparum malaria was defined as a malaria case occurring in the same patient in a maximum interval of 40 days between the day treatments was started and the day the next diagnosis was made.

Results: All malaria cases (7,171) notified between August 2012 and July 2013 were revised. About 23.72% (n = 1,701) were falciparum malaria. There were six cases of recurrent falciparum malaria that can be classified as treatment failure. All cases had low parasitemia. The minimum and maximum interval between the first and the recurrent malaria episode was 17 days and 33 days. Age range was 9 to 50 years. Two patients were from rural areas, while all others were from riverine areas.

Conclusion: Possible failure to Coartem treatment was identified, however causes are not clear. Further studies are needed.