Effect of alcoholic beverage consumption on the efficacy of artemisinin-based combination therapy in Plasmodium berghei-infected albino mice

Abstract

Malaria is one of the most significant parasitic diseases worldwide, with sub-Saharan Africa carrying the highest morbidity and mortality burden. Artemisinin-based combination therapies (ACTs) remain the recommended first-line treatment, but their efficacy may be influenced by concurrent alcohol use, a common but poorly studied practice in endemic areas. This study investigated the effect of alcohol consumption on the therapeutic performance of ACTs in Plasmodium berghe i-infected albino mice. Thirty male Swiss albino mice were inoculated intraperitoneally with chloroquine-sensitive P. Berghei and divided into ten groups (n = 3). Treatments included Artemether–Lumefantrine (AL) and Artesunate–Amodiaquine (AA), administered alone, or in combination with alcohol (beer 5.3% v/v) given before, during or after ACT administration. Parasitemia was monitored microscopically until Day 8 post-inoculation, when all animals were humanely euthanised and clinical signs were observed daily. Data were analyzed using one-way ANOVA followed by Turkey's post hoc test, with significance at p < 0.05. Both AL and AA significantly reduced parasitemia compared with controls. Mean parasite density was 2.26 ± 0.02 × 10⁴/µL in the AL group and 3.15 ± 0.02 × 10⁴/µL in the AA group, compared with 32.30 ± 1.48 × 10⁴/µL and 38.46 ± 1.63 × 10⁴/µL in the distilled-water and alcohol-only control groups, respectively (p < 0.05). However, alcohol co-administration reduced ACT efficacy, with higher parasite densities ranging from 11.32 ± 0.78 to 16.52 ± 1.16 × 10⁴/µL across alcohol-treated groups. Clinical scores were consistently lower in ACT-only groups than in alcohol-treated groups. The timing of alcohol administration did not significantly alter the negative impact. These findings indicated that alcoholic beverage consumption reduced the antimalarial efficacy of both AL and AA in P. berghei -infected mice, irrespective of whether alcohol was administered before, during or after ACT treatment. These findings provided experimental evidence supporting avoidance of alcoholic beverages during ACT therapy and warrant further pharmacokinetic and clinical investigations to determine the relevance of these interactions in human malaria.