Review: artesunate added to standard drug treatment reduces treatment failure in malaria

doi:10.1136/ebm.9.5.150

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Evidence-Based Medicine 2004; 9:150
© 2004 BMJ Publishing Group Ltd.

Therapeutics

Review: artesunate added to standard drug treatment reduces treatment failure in malaria

International Artemisinin Study Group. Artesunate combinations for treatment of malaria: meta-analysis. Lancet 2004;363:9–17.[CrossRef][Medline]

Q In patients with acute, uncomplicated Plasmodium falciparum malaria, does the addition of an artemisinin derivative (artesunate) to existing drug treatment reduce treatment failure and transmission potential?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Infectious disease $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Tropical medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: artemisinins • antimalarials • malaria (falciparum)

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline, Cochrane Central Register of Controlled Trials, andinvestigators in the field. Individual patient data were requestedfrom the original trial datasets.

Study selection and assessment: randomised controlled trials (RCTs) comparing artesunate plusa standard antimalarial drug with a standard drug alone foracute, uncomplicated P falciparum malaria. Study quality wasassessed by adequacy of random allocation, inclusion of alleligible patients in the analysis, and completeness of followup.

Outcomes: treatment failure rates at 14 and 28 days.

MAIN RESULTS
16 trials met the selection criteria (n = 5948). The backgrounddrugs used were chloroquine (3 RCTs done in Burkina Faso, IvoryCoast, and Sao Tome and Principe), amodiaquine (3 RCTs donein Gabon, Kenya, and Senegal), sulphadoxine-pyrimethamine (7RCTs done in Gambia, Kenya, Malawi, Peru, and Uganda), and mefloquine(3 RCTs done in Thailand). 12 RCTs were placebo controlled.All but 1 RCT assessed 3 days of artesunate. . . . [Full text of this article]

Mary M Fanning, MD, PhD

National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, Maryland, USA