Anti-malaria drug combination could help address treatment crisis...( Using a combination of two drugs--artem...),Health

Using a combination of two drugs--artemether and lumefantrine--is the most effective way to treat malaria in the areas of Africa where resistance to commonly used malaria drugs is high, concludes a randomised trial published in this week's issue of THE LANCET.

Cheap and effective treatment for malaria with one drug is no longer an option for most countries in Africa because of the rapid emergence of drug resistance. The parasite that causes the most severe form of malaria, Plasmodium falciparum, is resistant to the anti-malaria drug chloroquine in nearly all the areas where the disease is rife. This, along with the fact that resistance to sulfadoxine-pyrimethamine is spreading rapidly, has led to strong calls for the introduction of combination treatments. However, there is little data on the effectiveness of these combinations when used in routine practice.

Theonest Mutabingwa (London School of Hygiene and Tropical Medicine, UK) and colleagues compared the effectiveness of three drug combinations that are available in Africa, can be used in children, and stand a realistic chance of being deployed. Around 1800 children in Tanzania aged 4-59 months with malaria were recruited onto the trial between September 2002 and October 2004. They were randomly assigned to amodiaquine alone (270), amodiaquine and sulfadoxine-pyrimethamine (507), amodiaquine and artesunate (515), or artemether-lumefantrine (519). The drugs were taken orally at home to test their use under real-life conditions. Around 1700 children were followed-up 14 days after the start of treatment. Failure to clear malaria parasites from the blood was found in 42% of patients on amodiaquine, 20% on amodiaquine and sulfadoxine-pyrimethamine, 11% on amodiaquine-artesunate, and 1% on artemether-lumefantrine. Recruitment to the amodiaquine group was stopped early because of the high failure rate. 28 days after treatment, failure rates were higher in all groups but the failure rate was only 3% in
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
21-Apr-2005

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