Background: In 2012-2013, a pilot study on implementation
of community-based case malaria management by trained community health workers
was implemented in southern Katanga Province in the Democratic Republic of
Congo (DRC). We report one case of severe adverse reaction that was linked to
artesunate-amodiaquine (ASAQ). Case summary: An apparent healthy, 15-year-old
Congolese female with a positive rapid diagnostic test for Plasmodium falciparum without any sign of complications was
prescribed a fixed dose combination of ASAQ. Under direct observation, she took
two tablets of ASAQ (200 mg
AS/540mg AQ total) with water. Approximately 30 minutes later, she developed a
generalized pruritus and widespread urticarial rash, with marked periorbital
and forearm swelling. She was immediately referred to the nearest clinic. She
did not present with fever or any respiratory distress and was fully conscious.
She received dexamethasone 8 mg IV, followed 20 min later by 4 mg of chlorphenamine
orally. Approximately 40 minutes after, the rash and swellings had mostly resolved.
She received oral quinine as a second line treatment. Conclusion: This single
presentation was the only such occurrence from 1354 malaria-infected patients.
As ASAQ is the most widely used first-line treatment in the DRC, increased
awareness and close monitoring of the use of this drug are advised. Health care professionals should document,
report and provide immediate medical assistance.
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