Nutritional Advice El Mondo
Objectives:
The emergence of artemisinin resistance in Southeast Asia and Plasmodium falciparum kelch13 propeller gene mutations in sub-Saharan African pose the greatest threat to global efforts to control malaria. This is a critical concern in Uganda, where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated falciparum. Therefore, this review article has been conducted.
The objective of this review article is to compare the efficacy and safety of dihydroartemisinin-piperaquine (DHA-PQ) and artemether-lumefantrine (AL) for the treatment of uncomplicated falciparum malaria in Ugandan children?
Study design:
This review article included 11 RCTs with a total of 3,798 participants.
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 adults and 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.
A total dose of 5-24 mg/kg bw of artemether and 29-144 mg/kg bw of lumefantrine. Artemether + lumefantrine is given twice a day for 3 days (total, six doses). The first two doses should, ideally, be given 8 h apart.
Results and conclusions:
The investigators found PCR unadjusted treatment failure was significantly lower with dihydroartemisinin-piperaquine at day 28 [RR = 0.30, 95% CI = 0.19 to 0.49, participants = 7,863, studies = 5, I2 = 93%, low quality evidence] and at day 42 [RR = 0.53, 95% CI = 0.38 to 0.76, participants = 1,618, studies = 4, I2 = 79%, moderate quality of evidence].
The investigators found PCR adjusted treatment failure at day 42 was significantly lower with dihydroartemisinin-piperaquine treatment group [RR = 0.45, 95% CI = 0.28 to 0.72, participants = 1,370, studies = 5, high quality of evidence] and it was below 5% in both arms at day 28 (moderate quality of evidence).
The investigators found artemether-lumefantrine showed a longer prophylactic effect on new infections which may last for up to 63 days [PCR-adjusted treatment failure: RR = 2.04, 95% CI = 1.13 to 3.70, participants = 1,311, studies = 2, moderate quality of evidence].
The investigators found compared to artemether-lumefantrine, dihydroartemisinin-piperaquine was associated with a slightly higher frequency of cough [RR = 1.07, 95% CI = 1.01 to 1.13, 2,575 participants, 6 studies, high quality of evidence].
In both treatment groups, the risk of recurrent parasitaemia due to possible recrudescence was less than 5% at day 28.
The investigators found the appearance of gametocyte between 29 and 42 days was also significantly lower in dihydroartemisinin-piperaquine than artemether-lumefantrine [RR = 0.26, 95% CI = 0.12 to 0.56, participants = 623, studies = 2, I2 = 0%].
The investigators concluded compared to artemether-lumefantrine, dihydroartemisinin-piperaquine appears to reduce treatment failure and gametocyte carriage in Ugandan children. This may trigger dihydroartemisinin-piperaquine to become the first-line treatment option of uncomplicated falciparum malaria in Ugandan children. Both treatments were safe and well-tolerated.
Original title:
Efficacy and safety of dihydroartemisinin-piperaquine versus artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Ugandan children: a systematic review and meta-analysis of randomized control trials by Assefa DG, Zeleke ED, [...], Manyazewal T.
Link:
https://pubmed.ncbi.nlm.nih.gov/33794897/
Additional information of El Mondo:
Find more information/studies on RCTs/cohort/significantly/review article, malaria and food fortification/malnutrition right here.