Coartemether produces prompt reduction in fever in Plasmodium falciparum infection

Periodic fever is one of the characteristic symptoms of a malaria infection, and contributes to the malaise typical of the acute phase of the disease. It is due to the rupture of human erythrocytes, and the subsequent release of pyrogens into the blood stream associated with the parasite’s asexual reproductive phase. Fever clearance time (FCT) provides a means of measuring the degree of symptom control achieved by antimalarial treatments.

(Note that fever clearance time of coartemether varies markedly for each individual trial cited below - probably as a result of varying usage of antipyretics.)

Coartemether reduced fever significantly faster than certain comparator drugs. For example, when compared with chloroquine in India, the median fever clearance time was 18 hrs versus 27 hrs (p=0.046) in evaluable patients.² When coartemether was compared with mefloquine in Thailand, the median FCT was 32 hrs versus 54 hrs (p=0.003) in evaluable patients.³

In African children, fever clearance occurred significantly faster with coartemether than with sulfadoxine + pyrimethamine (Fig. 4).⁶

Rapid fever clearance with coartemether is due to the activity of its artemether component on the parasite. This was demonstrated in a study in Chinese patients, where artemether alone and coartemether produced a median fever clearance time of 21 and 24 hours respectively (in evaluable patients), but for lumefantrine alone, median fever clearance time was much longer, at 60 hours.⁷

Figure 4. African children with fever >37.5°C
Fever clearance (and hence, symptomatic improvement) occurred faster with coartemether than with sulfadoxine + pyrimethamine