title: Repeated artemisinin-based combination therapies in a malaria hyperendemic area of Mali: efficacy, safety, and public health impact.
abstract: Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.
authors: Issaka
authors: I
authors: Sagara
authors: Bakary
authors: B
authors: Fofana
authors: Jean
authors: J
authors: Gaudart
authors: Bakary
authors: B
authors: Sidibe
authors: Amadou
authors: A
authors: Togo
authors: Sekou
authors: S
authors: Toure
authors: Kassim
authors: K
authors: Sanogo
authors: Demba
authors: D
authors: Dembele
authors: Alassane
authors: A
authors: Dicko
authors: Roch
authors: R
authors: Giorgi
authors: Ogobara K
authors: OK
authors: Doumbo
authors: Abdoulaye A
authors: AA
authors: Djimde
mesh_terms: D000293:Adolescent; D000655:Amodiaquine / Q000009:adverse effects / Q000627:therapeutic use*; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008302:Mali / Q000453:epidemiology; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine