title: Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications.
abstract: A classic way of delaying drug resistance is to use an alternative when possible. We tested the malaria treatment Argemone mexicana decoction (AM), a validated self-prepared traditional medicine made with one widely available plant and safe across wide dose variations. In an attempt to reflect the real situation in the home-based management of malaria in a remote Malian village, 301 patients with presumed uncomplicated malaria (median age 5 years) were randomly assigned to receive AM or artesunate-amodiaquine [artemisinin combination therapy (ACT)] as first-line treatment. Both treatments were well tolerated. Over 28 days, second-line treatment was not required for 89% (95% CI 84.1-93.2) of patients on AM, versus 95% (95% CI 88.8-98.3) on ACT. Deterioration to severe malaria was 1.9% in both groups in children aged </=5 years (there were no cases in patients aged >5 years) and 0% had coma/convulsions. AM, now government-approved in Mali, could be tested as a first-line complement to standard modern drugs in high-transmission areas, in order to reduce the drug pressure for development of resistance to ACT, in the management of malaria. In view of the low rate of severe malaria and good tolerability, AM may also constitute a first-aid treatment when access to other antimalarials is delayed.
authors.affiliation: Antenna Technologies, Geneva, Switzerland. bertrand.graz@chuv.ch
authors.forename: Bertrand
authors.initials: B
authors.lastname: Graz
authors.forename: Merlin L
authors.initials: ML
authors.lastname: Willcox
authors.forename: Chiaka
authors.initials: C
authors.lastname: Diakite
authors.forename: Jacques
authors.initials: J
authors.lastname: Falquet
authors.forename: Florent
authors.initials: F
authors.lastname: Dackuo
authors.forename: Oumar
authors.initials: O
authors.lastname: Sidibe
authors.forename: Sergio
authors.initials: S
authors.lastname: Giani
authors.forename: Drissa
authors.initials: D
authors.lastname: Diallo
mesh_terms: D000293:Adolescent; D000655:Amodiaquine / Q000008:administration & dosage* / Q000009:adverse effects; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D031674:Argemone / Q000009:adverse effects; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008302:Mali / Q000453:epidemiology; D008517:Phytotherapy / Q000009:adverse effects / Q000379:methods*; D028321:Plant Preparations / Q000008:administration & dosage* / Q000009:adverse effects; D012423:Rural Health; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D028321:Plant Preparations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine