title: Malaria transmission after artemether-lumefantrine and dihydroartemisinin-piperaquine: a randomized trial.
abstract: BACKGROUND
  Artemisinin-based combination therapy (ACT) reduces the potential for malaria transmission, compared with non-ACTs. It is unclear whether this effect differs between ACTs.
  
  
  METHODS
  A total of 298 children (age, 6 months to 10 years) with uncomplicated falciparum malaria were randomized to artemether-lumefantrine (AL; n = 153) or dihydroartemisinin-piperaquine (DP; n = 145) in Mbita, a community in western Kenya. Gametocyte carriage was determined by molecular methods on days 0, 1, 2, 3, 7, 14, 28, and 42 after treatment initiation. The gametocyte infectiousness to mosquitoes was determined by mosquito-feeding assays on day 7 after beginning therapy.
  
  
  RESULTS
  The cumulative risk of recurrent parasitemia on day 42 after initiation of treatment, unadjusted by polymerase chain reaction findings, was 20.7% (95% confidence interval [CI], 14.4-28.2) for AL, compared with 3.7% (95% CI, 1.2-8.5) for DP (P < .001). The mean duration of gametocyte carriage was 5.5 days (95% CI, 3.6-8.5) for AL and 15.3 days (95% CI, 9.7-24.2) for DP (P = .001). The proportion of mosquitoes that became infected after feeding on blood from AL-treated children was 1.88% (43 of 2293), compared with 3.50% (83 of 2371) for those that fed on blood from DP-treated children (P = .06); the oocyst burden among mosquitoes was lower among those that fed on blood from AL-treated children (P = .005) CONCLUSIONS: While DP was associated with a longer prophylactic time after treatment, gametocyte carriage and malaria transmission to mosquitoes was lower after AL treatment.
  
  
  BACKGROUND
  NCT00868465.
authors.affiliation: Human Health Division, International Centre for Insect Physiology and Ecology, Mbita Point, Nairobi, Kenya.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sawa
authors.forename: Seif A
authors.initials: SA
authors.lastname: Shekalaghe
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Drakeley
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Sutherland
authors.forename: Collins K
authors.initials: CK
authors.lastname: Mweresa
authors.forename: Amrish Y
authors.initials: AY
authors.lastname: Baidjoe
authors.forename: Alphaxard
authors.initials: A
authors.lastname: Manjurano
authors.forename: Reginald A
authors.initials: RA
authors.lastname: Kavishe
authors.forename: Khalid B
authors.initials: KB
authors.lastname: Beshir
authors.forename: Rahma U
authors.initials: RU
authors.lastname: Yussuf
authors.forename: Sabah A
authors.initials: SA
authors.lastname: Omar
authors.forename: Cornelus C
authors.initials: CC
authors.lastname: Hermsen
authors.forename: Lucy
authors.initials: L
authors.lastname: Okell
authors.forename: Henk D F H
authors.initials: HD
authors.lastname: Schallig
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sauerwein
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Hallett
authors.forename: Teun
authors.initials: T
authors.lastname: Bousema
mesh_terms: D000818:Animals; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D009033:Culicidae / Q000469:parasitology; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007630:Kenya; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission*; D008297:Male; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011804:Quinolines / Q000008:administration & dosage*; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D010879:Piperazines
chemical_list: D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines