Addition of artesunate to standard antimalarial drugs reduces treatment failure*1

Abstract

What is the effect of adding artesunate to existing drug regimens for people with acute uncomplicated Plasmodium falciparum malaria? Systematic review with meta-analysis. 16 trials met inclusion criteria. Standard antimalarial drugs in the trials varied (sulfadoxine–pyrimethamine: 7 RCTs; amodiaquine: 3 RCTs; chloroquine: 3 RCTs; mefloquine: 3 RCTs). Adding artesunate for 3 days to standard antimalarial drugs significantly reduced 14 and 28 day's failure rates compared with standard drugs alone (15 RCTs; OR for failure by 14 day 0.20, 95% CI 0.17 to 0.25; OR for failure by 28 days 0.23, 95% CI 0.19 to 0.28). Addition of artesunate for 1 day was not as effective as 3 days, but still significantly reduced failure rates compared with standard drugs alone (6 RCTs; OR for failure by 14 days 0.61, 95% CI 0.48 to 0.77; OR for failure by 28 days 0.68, 95% CI 0.53 to 0.89). The incidence of side effects was similar in both groups. Adding artesunate to a standard antimalarial drug regimen for 3 days leads to a consistent decrease in treatment failure at 14 days, irrespective of the standard antimalarial drug used.