Artemisinin-based combinations : Current Opinion in Infectious Diseases (original) (raw)
Antimicrobial agents: parasitic/viral
aShoklo Malaria Research Unit, Mae Sot, Tak, Thailand
bFaculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
cCentre for Clinical Vaccinology and Tropical Medicine Churchill Hospital, Old Road, Headington, Oxford, UK
Correspondence to Professor Nicholas J. White, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand Tel: +66 2 354 9172; fax: +66 2 354 9169; e-mail: [email protected]
Abstract
Purpose of review
Artemisinin-based combination treatments have been the mainstay of treatment for falciparum malaria in Southeast Asia for more than 10 years and are now increasingly recommended as first-line treatment throughout the rest of the world.
Recent findings
A large multicentre randomised trial conducted in East Asia has shown a 35% reduction in mortality from severe malaria following treatment with parenteral artesunate compared with quinine. There is increasing evidence that artemisinin-based combination treatments are safe and rapidly effective. Artemether–lumefantrine (six doses) has been shown to be very effective in large trials reported from Uganda and Tanzania. A once daily three-dose treatment of dihydroartemisinin piperaquine, a newer fixed combination, was a highly efficacious and well tolerated treatment for multi-drug resistant falciparum malaria in Southeast Asia.
Summary
Early diagnosis and treatment of uncomplicated malaria with effective drugs remains a priority as part of a comprehensive malaria control strategy. Artemisinin-based combination treatments have consistently been shown to be highly effective and safe. The challenge is to make them accessible in tropical countries.
© 2005 Lippincott Williams & Wilkins, Inc.