title: Randomized trials of artemisinin-piperaquine, dihydroartemisinin-piperaquine phosphate and artemether-lumefantrine for the treatment of multi-drug resistant falciparum malaria in Cambodia-Thailand border area.
abstract: BACKGROUND
  Drug resistance of falciparum malaria is a global problem. Sulphadoxine/pyrimethamine-resistant and mefloquine-resistant strains of falciparum malaria have spread in Southeast Asia at lightning speed in 1980s-1990s, and the Cambodia-Thailand border is one of the malaria epidemic areas with the most severe forms of multi-drug resistant falciparum malaria.
  
  
  METHODS
  Artemisinin-piperaquine (AP), dihydroartemisinin-piperaquine phosphate (DHP) and artemether-lumefantrine (AL) were used to treat 110, 55 and 55 uncomplicated malaria patients, respectively. The total dosage for adults is 1,750 mg (four tablets, twice over 24 hours) of AP, 2,880 mg (eight tablets, four times over two days) of DHP, and 3,360 mg (24 tablets, six times over three days) of AL. The 28-day cure rate, parasite clearance time, fever clearance time, and drug tolerance of patients to the three drugs were compared. All of the above methods were consistent with the current national guidelines.
  
  
  RESULTS
  The mean parasite clearance time was similar in all three groups (66.7 ± 21.9 hrs, 65.6 ± 27.3 hrs, 65.3 ± 22.5 hrs in AP, DHP and AL groups, respectively), and there was no remarkable difference between them; the fever clearance time was also similar (31.6 ± 17.7 hrs, 34.6 ± 21.8 hrs and 36.9 ± 15.4 hrs, respectively). After following up for 28-days, the cure rate was 95.1%(97/102), 98.2%(54/55) and 82.4%(42/51); and the recrudescence cases was 4.9%(5/102), 1.8%(1/55) and 17.6%(9/51), respectively. Therefore, the statistical data showed that 28-day cure rate in AP and DHP groups was superior to AL group obviously.The patients had good tolerance to all the three drugs, and some side effects (anoxia, nausea, vomiting, headache and dizziness) could be found in every group and they were self-limited; patients in control groups also had good tolerance to DHP and AL, there was no remarkable difference in the three groups.
  
  
  CONCLUSIONS
  AP, DHP and AL all remained efficacious treatments for the treatment of falciparum malaria in Cambodia-Thailand border area. However, in this particular setting, the AP regimen turned out to be favourable in terms of efficacy and effectiveness, simplicity of administration, cost and compliance.
  
  
  BACKGROUND
  The trial was registered at Chinese Clinical Trial Register under identifier 2005L01041.
authors.affiliation: Research Center for Qinghao (Artemisia annual L.), Guangzhou University of Chinese Medicine, Guangzhou, China. songjpgz@yahoo.com.cn
authors.forename: Jianping
authors.initials: J
authors.lastname: Song
authors.forename: Duong
authors.initials: D
authors.lastname: Socheat
authors.forename: Bo
authors.initials: B
authors.lastname: Tan
authors.forename: Suon
authors.initials: S
authors.lastname: Seila
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: Fengzhen
authors.initials: F
authors.lastname: Ou
authors.forename: Sreng
authors.initials: S
authors.lastname: Sokunthea
authors.forename: Leap
authors.initials: L
authors.lastname: Sophorn
authors.forename: Chongjun
authors.initials: C
authors.lastname: Zhou
authors.forename: Changsheng
authors.initials: C
authors.lastname: Deng
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Guoqiao
authors.initials: G
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage*; D002160:Cambodia; D002648:Child; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis / Q000188:drug therapy; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000302:isolation & purification; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials