title: Safety and efficacy of dihydroartemisinin/piperaquine (Artekin) for the treatment of uncomplicated Plasmodium falciparum malaria in Rwandan children.
abstract: In Rwanda, amodiaquine+sulfadoxine/pyrimethamine (AQ+SP) is the current first-line treatment for malaria, introduced in 2001 as an interim strategy before the future deployment of an artemisinin-based combination treatment (ACT). Dihydroartemisinin/piperaquine (DHA-PQP) is a new co-formulated and well tolerated ACT increasingly used in Southeast Asia where it has proved to be highly effective against Plasmodium falciparum malaria. We tested the efficacy, safety and tolerability of DHA-PQP in children with uncomplicated P. falciparum malaria. A randomised, open trial was carried out in 2003-2004. Seven hundred and sixty-two children aged 12-59 months with uncomplicated P. falciparum malaria were randomly allocated to one of the following treatments: amodiaquine+artesunate; AQ+SP; or DHA-PQP. Patients were followed-up until Day 28 after treatment. Adverse events and clinical and parasitological outcomes were recorded. Children treated with DHA-PQP or AQ+AS had a significantly higher cure rate compared with those treated with amodiaquine+sulfadoxine/pyrimethamine (95.2% and 92.0% vs. 84.7%, respectively). Parasite clearance was significantly faster in children treated with DHA-PQP and AQ+AS compared with those treated with amodiaquine+sulfadoxine/pyrimethamine. The frequency of adverse events was significantly lower in patients treated with DHA-PQP than in those treated with combinations containing amodiaquine. A 3-day treatment with DHA-PQP proved to be efficacious with a good safety and tolerability profile and could be a good candidate for the next first-line treatment.
authors.affiliation: National Malaria Control Program, Kigali, Rwanda.
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.forename: Caterina I
authors.initials: CI
authors.lastname: Fanello
authors.forename: Chantal
authors.initials: C
authors.lastname: van Overmeir
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: van Geertruyden
authors.forename: Walli
authors.initials: W
authors.lastname: van Doren
authors.forename: Daniel
authors.initials: D
authors.lastname: Ngamije
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects*; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D011804:Quinolines / Q000008:administration & dosage / Q000009:adverse effects*; D012432:Rwanda; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D011804:Quinolines; D012717:Sesquiterpenes; C039060:artenimol; C034759:piperaquine; D010879:Piperazines