Repeated Artemisinin-Based Combination Therapies in a Malaria Hyperendemic Area of Mali: Efficacy, Safety, and Public Health Impact

• Published in: The American journal of tropical medicine and hygiene Vol. 87; no. 1; pp. 50 - 56
• Main Authors: SAGARA, Issaka, FOFANA, Bakary, DOUMBO, Ogobara K, DJIMDE, Abdoulaye A, GAUDART, Jean, SIDIBE, Bakary, TOGO, Amadou, TOURE, Sekou, SANOGO, Kassim, DEMBELE, Demba, DICKO, Alassane, GIORGI, Roch
• Format: Journal Article
• Language: English
• Published: Deerfield, IL American Society of Tropical Medecine and Hygiene 01.07.2012; American Society of Tropical Medicine and Hygiene; The American Society of Tropical Medicine and Hygiene
• Subjects: Adolescent; Amodiaquine - adverse effects; Amodiaquine - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials - administration & dosage; Antimalarials - adverse effects; Antimalarials - therapeutic use; Antiparasitic agents; Applications; Artemether, Lumefantrine Drug Combination; Artemisinins - adverse effects; Artemisinins - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Drug Combinations; Dynamical Systems; Ecology, environment; Emerging diseases; Environment and Society; Environmental Sciences; Ethanolamines - adverse effects; Ethanolamines - therapeutic use; Female; Fluorenes - adverse effects; Fluorenes - therapeutic use; Health; Human health and pathology; Human protozoal diseases; Humans; Infectious diseases; Life Sciences; Malaria; Malaria - drug therapy; Malaria - epidemiology; Male; Mali - epidemiology; Mathematics; Medical sciences; Methodology; Microbiology and Parasitology; Parasitic diseases; Parasitology; Pharmacology. Drug treatments; Probability; Protozoal diseases; Pyrimethamine - adverse effects; Pyrimethamine - therapeutic use; Santé publique et épidémiologie; Statistics; Sulfadoxine - adverse effects; Sulfadoxine - therapeutic use; Mali; Africa; Infection; Antimalarial; Protozoal disease; Drug combination; Malaria; Artemisinin; Parasiticide; Tropical medicine; Combined treatment; Parasitosis; Public health
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.2012.11-0649

Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.