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Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treating uncomplicated malaria: a randomized trial to guide policy in Uganda
- Source :
- PLoS ONE, Vol 3, Iss 6, p e2390 (2008), PLoS ONE, PloS one, vol 3, iss 6
- Publication Year :
- 2008
- Publisher :
- Public Library of Science (PLoS), 2008.
-
Abstract
- Author(s): Yeka, Adoke; Dorsey, Grant; Kamya, Moses R; Talisuna, Ambrose; Lugemwa, Myers; Rwakimari, John Bosco; Staedke, Sarah G; Rosenthal, Philip J; Wabwire-Mangen, Fred; Bukirwa, Hasifa | Abstract: BackgroundUganda recently adopted artemether-lumefantrine (AL) as the recommended first-line treatment for uncomplicated malaria. However, AL has several limitations, including a twice-daily dosing regimen, recommendation for administration with fatty food, and a high risk of reinfection soon after therapy in high transmission areas. Dihydroartemisinin-piperaquine (DP) is a new alternative artemisinin-based combination therapy that is dosed once daily and has a long post-treatment prophylactic effect. We compared the efficacy and safety of AL with DP in Kanungu, an area of moderate malaria transmission.Methodology/principal findingsPatients aged 6 months to 10 years with uncomplicated falciparum malaria were randomized to therapy and followed for 42 days. Genotyping was used to distinguish recrudescence from new infection. Of 414 patients enrolled, 408 completed follow-up. Compared to patients treated with artemether-lumefantrine, patients treated with dihydroartemisinin-piperaquine had a significantly lower risk of recurrent parasitaemia (33.2% vs. 12.2%; risk difference = 20.9%, 95% CI 13.0-28.8%) but no statistically significant difference in the risk of treatment failure due to recrudescence (5.8% vs. 2.0%; risk difference = 3.8%, 95% CI -0.2-7.8%). Patients treated with dihydroartemisinin-piperaquine also had a lower risk of developing gametocytaemia after therapy (4.2% vs. 10.6%, p = 0.01). Both drugs were safe and well tolerated.Conclusions/significanceDP is highly efficacious, and operationally preferable to AL because of a less intensive dosing schedule and requirements. Dihydroartemisinin-piperaquine should be considered for a role in the antimalarial treatment policy of Uganda.Trial registrationControlled-Trials.com ISRCTN75606663.
- Subjects :
- Artemether/lumefantrine
Public Health and Epidemiology/Infectious Diseases
lcsh:Medicine
Pharmacology
law.invention
Randomized controlled trial
Dihydroartemisinin/piperaquine
law
Medicine
Uganda
Artemisinin
Malaria, Falciparum
Child
lcsh:Science
Multidisciplinary
Health Policy
Absolute risk reduction
Artemisinins
Infectious Diseases
Ethanolamines
6.1 Pharmaceuticals
Child, Preschool
Combination
Quinolines
HIV/AIDS
Drug Therapy, Combination
Artemether
Infection
medicine.drug
Research Article
Falciparum
Infectious Diseases/Epidemiology and Control of Infectious Diseases
medicine.medical_specialty
Combination therapy
General Science & Technology
Clinical Trials and Supportive Activities
Public Health and Epidemiology
Lower risk
Antimalarials
Rare Diseases
Drug Therapy
Clinical Research
Internal medicine
parasitic diseases
Humans
Preschool
Fluorenes
Lumefantrine
business.industry
Prevention
lcsh:R
Evaluation of treatments and therapeutic interventions
Infant
medicine.disease
Malaria
Vector-Borne Diseases
Orphan Drug
lcsh:Q
business
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 3
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....abb03cbaa4ba97a27fab7dd41af1f46b