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08-11-2011 | General practice | Article

DHAPQ best option for children with uncomplicated malaria


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MedWire News: A large study carried out in sub-Saharan Africa suggests that three out of four commonly used artemisinin-based combination therapies (ACTs) are effective for treatment of uncomplicated Plasmodium falciparum malaria in young children, with dihydroartemisinin-piperaquine (DHAPQ) having the best results overall.

"ACTs are the mainstay for the management of uncomplicated malaria cases," explain Umberto d'Allessandro (Institute of Tropical Medicine, Antwerp, Belgium) and colleagues from the Four Artemisinin-Based Combinations Study Group.

"However, up-to-date data able to assist sub-Saharan African countries formulating appropriate antimalarial drug policies are scarce," they add.

To address this, a randomized trial of four ACTs - DHAPQ, amodiaquine-artesunate (ASAQ), artemether-lumefantrine (AL), and chlorproguanil-dapsone-artesunate (CD+A) - was carried out in 4116 children under the age of 5 years from seven sub-Saharan countries across 12 sites in total.

All the children had uncomplicated P. falciparum malaria. At least three of the four ACTs were used at each site and overall 1226 were treated with AL, 1002 with ASAQ, 413 with CD+A, and 1475 with DHAPQ between July 2007 and June 2009. They were followed-up until day 28 to assess outcomes and side-effects and then passively followed-up for 6 months.

CD+A was the least effective of the four and caused the most side effects leading the researchers to withdraw it early from the study.

Of the three remaining ACTs, all showed good efficacy and tolerable side effects for treating P. falciparum infection in young children. However, direct comparison showed DHAPQ to be the most effective at preventing re-infection with malaria soon after treatment followed by ASAQ and AL.

AL and ASAQ are already recommended as potential treatments in the antimalarial drug policies of many African countries in this region, but these findings support the recommendation of the World Health Organization that DHAPQ should also be considered as a suitable therapeutic option, note the researchers.

"This study confirms that DHAPQ is a valid third option for the treatment of uncomplicated P. falciparum malaria, as its efficacy is excellent and comparable to the other ACTs, while its long post-treatment prophylaxis could be an additional advantage," write the authors in the journal PLoS Medicine.

They conclude: "Because these findings are based on pooled results from seven sub-Saharan African countries, they are likely to be generalizable and thus of use in setting national antimalarial drug policies throughout the region."

By Helen Albert

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