Early vomiting, diarrhoea and cough are more frequent in African children treating with DHA-PQ than that of AL

Objectives:
What is the safety of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated P. falciparum malaria among children in Africa?

Study design:
This review article included 18 studies involving 10,498 African children with uncomplicated P. falciparum malaria.

A target dose (range) of 4 (2-10) mg/kg bw per day dihydroartemisinin and 18 (16-27) mg/kg bw per day piperaquine given once a day for 3 days for children weighing ≥25 kg.
The target doses and ranges for children weighing 25 kg are 4 (2.5-10) mg/kg bw per day dihydroartemisinin and 24 (20-32) mg/kg bw per day piperaquine once a day for 3 days.

Results and conclusions:
The investigators found, compared to AL, DHA-PQ significantly increased frequency of early vomiting with 126% [RR = 2.26, 95% CI = 1.46 to 3.50, I2 = 0%, participants = 7,796, studies = 10, high quality of evidence].

The investigators found, compared to AL, DHA-PQ significantly increased frequency of cough with 6% [RR = 1.06, 95% CI = 1.01 to 1.11, I2 = 0%, participants = 8,013, studies = 13, high quality of evidence].

The investigators found, compared to AL, DHA-PQ significantly increased frequency of diarrhoea with 16% [RR = 1.16, 95% CI = 1.03 to 1.31, I2 = 8%, participants = 6,841, studies = 11, high quality of evidence].

The investigators concluded that both drugs are well tolerated by children. There are comparable occurrences of adverse events in both treatment arms. But, early vomiting, diarrhoea and cough are common and more frequent in African children who are treated with the DHA-PQ than that of AL (high quality of evidence). All serious adverse events are consistent with malaria symptoms and judged to be unrelated to study medication. More studies comparing AL with DHA-PQ are needed to determine the comparative safety of these drugs.

Original title:
Safety of dihydroartemisinin-piperaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa: a systematic review and meta-analysis of randomized control trials by Assefa DG, Zeleke ED, […], Makonnen E.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725395/

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