Pharmacokinetics of Antimalarials in Breastfeeding Ugandan Mother-infant Pairs

Lactating women requiring treatment for uncomplicated malaria will be identified and invited for sampling. The decision to treat them with first-line treatment will have been made by the clinician, not by a member of the study team. The study team will not make any adjustments to the prescribed treatment. Artemether-lumefantrine comprises six doses of medication, with the initial two doses given 8 hours apart on Day 1, and dosing 12-hourly on Day 2 and Day 3. Intensive pharmacokinetic sampling will be undertaken after Dose 5, as indicated in the schema under Section 5: plasma and breastmilk samples will be obtained pre-dose and at 2, 4, 6, 8 hours after dose. In addition, sparse sampling will be undertaken on either of these occasions; at pre-dose and between 1 to 6 hours after the first dose; a trough (pre-dose) sample after the Dose 3 or Dose 4 and lastly at 5, 7, and up to 14-days after the first dose. A heelprick sample will also be obtained from the breastfed infants at maternal trough (prior to maternal dose) and at a random timepoint (once per infant) over the 8-hour pharmacokinetic sampling visit to characterize concentrations of these drugs over an 8-hour dosing interval. In addition, a single heelprick sample will be obtained from the infant whenever the mother returns after treatment for the late sampling time points (5, 7, and 14 days post the first dose). Due to the long half-life of lumefantrine of approximately 6 days plasma sampling will be performed up to day 14 to characterise the terminal elimination of the drug. Concentrations of total plasma and breastmilk lumefantrine and desbutyl-lumefantrine will be determined.

Inclusion Criteria:A personally signed and dated informed consent document indicating that the participant has been informed of all pertinent aspects of the study.Participants who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.Woman is aged 18 years or older, and mothers between the age of 14-17, who are considered emancipated minors.Receiving treatment for uncomplicated malariaBreastfeeding at enrolmentExclusion Criteria:Severe maternal or infant illness which in the opinion of the patient's clinician would interfere with her participation in the studyBreastfed infant is aged over 12 monthsPartner objection to participate in the studyMaternal objection to infant participation