4
17
1
1
Case 2
our patients. Symptoms of Artemeter -Lumafanthrine
vary and could present as urticarial rash, itching, swell-
ing of the lips, wheezing, hives and systemic features as
hypotension, fainting, palpitations etc. Our patients pre-
sented with uticarial rash, itching and swelling of the
l1i2ps and hives but only one presented with hypotension.
At times it can make the skin blister and peel: A phe-
EK is a 3- year old male who presented in a clinic with a
two days history of fever, vomiting, diarrhea and weak-
ness of 3 days duration. On examination, he was found
to be lethargic but in no obvious respiratory distress.
Other findings were normal. He was diagnosed as acute
uncomplicated malaria and then placed on Intravenous
fluids and Intravenous Artesunate. Just few minutes
later, we noted generalized urticarial rash and maculo-
papular rash. Vital signs were within normal ranges.
A diagnosis of adverse drug reaction was made, and
patient was placed on Intravenous hydrocortisone and
promethazine. The rash cleared thereafter.
1
1
nomenom called Toxic epidermal necrolysis(TEN).
None of our series presented with palpitations nor TEN.
Combisunate is an artemether-lumefantrine derivative
which side effects were mild, did not lead to artemether-
lumefantrine discontinuation, and can resolve. Hartz et
al noted that artemether-lumefantrine 6-dose regimen
was discontinued in 0.2% of adult patients due to side
1
2
effects. He also noted few adverse effects in his series.
Case 3
Urticaria was reported in less than 3% of his patients.
Serious skin reactions (bullous eruption) have been
1
3
B is a 3 month old male who presented with fever and
poor sucks at breast of three days duration. Systemic
examination revealed no obvious abnormality. A tenta-
tive diagnosis of malaria was made. He was given intra-
muscular Artemerter, after which fever subsided. The
parenteral drug was then changed to syrup P-alaxin 8mls
daily for three days. On the third day of commencement
of this drug, baby was brought back to the hospital with
an urticarial and maculopapular rash. Pulse rate then was
reported rarely during postmarketing experience. Neu-
rological deficits and ototoxicity have been reporte3d in
1
some cases of artemerter –Lumenfantrin ingestion. our
series had urticaria and a bullous eruption on their lips
but no neurological deficits or hearing problems. The
relationship between the drug intake and the onset of
clinical symptoms is critical. Unless the patient has been
previously sensitized to a drug, the interval between
initiation of therapy and the onset of reaction1 is rarely
1
1
42 beat per minute and respiratory rate was 68 cycles
less than one week or more than one month. Our first
per minute (tachypnoea). The patient was managed with
antihistamine and low dose steroid; he is doing well as
at the time of writing this report
and second cases occurred few hours after initiation of
therapy while the third occurred after two days.
The most important measure in managing drug hyper-
sensitivity reacti4ons is the discontinuation of the offend-
1
ing medication. Alternative medications with unrelated
Discussion
chemical structures should be substituted when avail-
able. In the majority of patients, symptoms will resolve
within two we4eks if the diagnosis of drug hypersensitiv-
Adverse drug reaction is an unpleasant reaction, which
results from an intervention related to the use of a me-
dicinal product which predicts hazard from future ad-
ministration, and warrants prevention or a specific treat-
ment or alt9eration of the dosage regimen or withdrawal
of product.
1
ity is correct. All the signs and symptoms resolved in
one of our patients within minutes while the other two
happened in just three days after treatment. Additional
therapy for drug hypersensi1t1ivity reactions is largely
supportive and symptomatic. Systemic corticosteroids
may speed recovery (a1s1 in our patient) in some cases of
drug hypersensitivity. Topical corticosteroids and oral
antihistamines may improve dermatologic symptoms.
Antihistamines were used in all our cases and we had
good response.
Adverse drug reactions caused by immune and nonim-
mune mechanisms are a major cause of morbidity and
mortality worldwide. They are the most common iatro-
genic illness, c0omplicating 5 to 15 percent of therapeutic
1
drug courses. Three to six percent of all hospital ad-
missions are because of adverse drug reactions, and 6 to
1
5 percent of hospitalized patients (2.2 million persons
in the United State1s0 in 1994) experience a serious ad-
verse drug reaction.
Conclusion
The body’s response can affect many organ systems but
the skin is the organ most frequently involved as seen in
Artemether-lumefantrine combination can lead to minor
skin related adverse events.
References
2
.
WHO Guidelines for the treatment
3. Golenser J, Waknine JH, Krugliak
M, Hunt NH, Grau GE. Current
perspectives on the mechanism of
action of artemisinins. Interna-
tional Journal for Parasitology
1
.
WHO World Malaria Report 2008.
Obtainable at http://www.who.int/
malaria/wmr2008/ accessed on
May 2012]
of malaria 2006 [obtainable at
http://www.who.int/malaria/docs/
TreatmentGuidelines2006.pdf
accessed on May 2012]
[
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006; 36: 1427–41.