Efficacy of quinine, artemether-lumefantrine and dihydroartemisinin-piperaquine as rescue treatment for uncomplicated malaria in Ugandan children

A. Yeka, J. Tibenderana, J. Achan, Umberto D'Alessandro, A.O. Talisuna

    Research output: Contribution to journalA1: Web of Science-article

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    Abstract

    BACKGROUND: The treatment of falciparum malaria poses unique challenges in settings where malaria transmission intensity is high because recurrent infections are common. These could be new infections, recrudescences, or a combination of the two. Though several African countries continue to use quinine as the second line treatment for patients with recurrent infections, there is little information on its efficacy when used for rescue therapy. Moreover, such practice goes against the World Health Organisation (WHO) recommendation to use combination therapy for uncomplicated malaria. METHODS: We conducted a nested, randomized, open label, three-arm clinical trial of rescue therapy in children 6-59 months old with recurrent malaria infection during 28 days post treatment with artemisinin combination treatment (ACT). Patients were randomly assigned to receive either quinine, artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHAPQ), and actively followed up for 28 days. FINDINGS: Among 220 patients enrolled, 217 (98(.)6 %) were assigned an efficacy outcome and 218 (99(.)1 %) were assessed for safety. The risk of recurrent infection was significantly higher in patients treated with quinine (70 %, 74/110, HR = 3(.)9; 95 % CI: 2(.)4-6(.)7, p
    Original languageEnglish
    JournalPLoS ONE
    Volume8
    Issue number1
    Pages (from-to)e53772
    ISSN1932-6203
    DOIs
    Publication statusPublished - 2013

    Keywords

    • Protozoal diseases
    • Malaria
    • Plasmodium falciparum
    • Vectors
    • Mosquitoes
    • Anopheles
    • Infections
    • Recurrence
    • Recrudescence
    • Second-line drugs
    • Quinine
    • Children
    • Artemisinin combination therapies (ACT)
    • ACT
    • Artemether-lumefantrine
    • Dihydroartemisinin-piperaquine
    • Efficacy
    • Uganda
    • Africa-East

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