Artemisinin-based combination therapy for treating uncomplicated malaria.

Area of Science:

• Malariology
• Pharmacology
• Infectious Diseases

Background:

• The World Health Organization (WHO) recommends Artemisinin-based Combination Therapy (ACT) for uncomplicated P. falciparum malaria.
• This review evaluates the comparative benefits and harms of available ACT and non-ACT treatment options.

Purpose of the Study:

• To compare the efficacy and safety of various ACTs and non-ACTs for treating uncomplicated P. falciparum malaria.

Main Methods:

• Systematic review of randomized head-to-head trials of ACTs for uncomplicated P. falciparum malaria.
• Searched multiple databases up to March 2009, including Cochrane, MEDLINE, and EMBASE.
• Analyzed primary outcomes using risk ratios (RR) and 95% confidence intervals (CI), focusing on PCR-adjusted failure rates, P. vivax incidence, gametocyte carriage, hemoglobin levels, and adverse events.

Main Results:

• Fifty studies met inclusion criteria; all five ACTs achieved <10% PCR-adjusted failure rates, meeting WHO recommendations.
• Dihydroartemisinin-piperaquine showed comparable or superior performance to artesunate plus mefloquine and artemether-lumefantrine.
• ACTs were superior to amodiaquine plus sulfadoxine-pyrimethamine in East Africa; dihydroartemisinin-piperaquine and artesunate plus mefloquine were more effective than artemether-lumefantrine in reducing P. vivax incidence.

Conclusions:

• Dihydroartemisinin-piperaquine is an effective first-line treatment for P. falciparum malaria.
• Amodiaquine plus sulfadoxine-pyrimethamine's efficacy is below WHO recommendations in some African regions.
• ACTs with long half-lives may benefit P. vivax radical cure where primaquine is not used.