Artemisinin Combination Therapies for Treatment of Uncomplicated Malaria in Uganda

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dc.creatorBukirwa, Hasifa
dc.creatorTalisuna, Ambrose
dc.creatorYeka, Adoke
dc.creatorKamya, Moses R
dc.creatorTalisuna, Ambrose O.
dc.creatorBanek, Kristin
dc.creatorBakyaita, Nathan
dc.creatorRwakimari, John Bosco
dc.creatorRosenthal, Philip J.
dc.creatorWabwire-Mangen, Fred
dc.creatorDorsey, Grant
dc.creatorStaedke, Sarah G.
dc.date2012-02-02T16:11:42Z
dc.date2012-02-02T16:11:42Z
dc.date2006-05
dc.date.accessioned2018-09-04T12:32:26Z
dc.date.available2018-09-04T12:32:26Z
dc.descriptionObjectives: To compare the efficacy and safety of artemisinin combination therapies for the treatment of uncomplicated falciparum malaria in Uganda. Design: Randomized single-blind controlled trial. Setting: Tororo, Uganda, an area of high-level malaria transmission. Participants: Children aged one to ten years with confirmed uncomplicated P. falciparum malaria. Interventions: Amodiaquine þ artesunate or artemether–lumefantrine. Outcome Measures: Risks of recurrent symptomatic malaria and recurrent parasitemia at 28 days, unadjusted and adjusted by genotyping to distinguish recrudescences and new infections. Results: Of 408 participants enrolled, 403 with unadjusted efficacy outcomes were included in the per-protocol analysis. Both treatment regimens were highly efficacious; no recrudescencesoccurred in patients treated with amodiaquine þ artesunate, and only two occurred in those treated with artemether–lumefantrine. However, recurrent malaria due to new infections was common. The unadjusted risk of recurrent symptomatic malaria was significantly lower for participants treated with artemether–lumefantrine than for those treated with amodiaquine þ artesunate (27% versus 42%, risk difference 15%, 95% CI 5.9%–24.2%). Similar results were seen for the risk of recurrent parasitemia (51% artemether–lumefantrine versus 66% amodiaquineþ artesunate, risk difference 16%, 95% CI 6.2%–25.2%). Amodiaquine þ artesunate and artemether–lumefantrine were both well-tolerated. Serious adverse events were uncommon with both regimens. Conclusions: Amodiaquine þ artesunate and artemether–lumefantrine were both highly efficacious for treatment of uncomplicated malaria. However, in this holoendemic area, despite the excellent performance of both regimens in terms of efficacy, many patients experienced recurrent parasitemia due to new infections. Artemether–lumefantrine was superior to amodiaquine þ artesunate for prevention of new infections. To maximize the benefit of artemisinin combination therapy in Africa, treatment should be integrated with strategies to prevent malaria transmission. The impact of frequent repeated therapy on the efficacy, safety, and cost-effectiveness of new artemisinin regimens should be further investigated.
dc.descriptionThe Centers for Disease Control and Prevention/Association of Schools of Public Health cooperative agreement, ‘‘Malaria Surveillance and Control in Uganda’’ (SA3569 and S1932–21/21), and the Department for International Development (DFID) provided financial support for this study.
dc.identifierBukirwa, H., Yeka, A., Kamya, M.R., Talisuna, A.O., Banek, K., Bakyaita, N., Wabwire-Mangen, F., Rwakimari, J.B., Staedke, S.G., Rosenthal, P.J., Dorsey, G. (2006). Artemisinin combination therapies for treatment of uncomplicated malaria in Uganda. PLoS Clinical Trials, 1(1)
dc.identifier1555-5887
dc.identifierDOI: 10.1371/journal.pctr. 0010007
dc.identifierhttp://hdl.handle.net/10570/379
dc.identifier.urihttp://hdl.handle.net/10570/379
dc.languageen
dc.publisherPublic Library of Science
dc.subjectMalaria parasites
dc.subjectChloroquine drugs
dc.subjectArtemisinin-based combination therapies (ACTs)
dc.subjectUganda
dc.subjectUncomplicated falciparum malaria
dc.subjectMalaria
dc.titleArtemisinin Combination Therapies for Treatment of Uncomplicated Malaria in Uganda
dc.typeJournal article, peer reviewed
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