Antimalarial drug combinations in vastly different settings

Abstract

Today The Lancet features two randomised trials of different anti malarial drug combinations. Issaka Zongo and colleagues compared artemether-lumefantrine with amodiaquine-sulfadoxine-pyrimethamine in patients presenting with Plasmodium falciparum malaria to an outpatient department in Bobo-Dioulasso Burkina Faso. The catchment area here has high-intensity transmission (ento mological inoculation rate over 100). Alison Ratcliff and colleagues compared artemether-lumefantrine with dihydroartemisinin-piperaquine in outpatients presenting with either P falciparum or Plasmodium vivax malaria or both in Papua Indonesia from a low-to-mid level transmission area (entomological inoculation rate under 10). Each study has unique aspects. Zongo and colleagues found that amodiaquine-sulfadoxine-pyrimethamine was just as effective as artemether-lumefantrine in treating uncomplicated P falciparum infection and contested the notion that all antimalarial combinations should contain an artemisinin-based drug. Besides an equivalent effectiveness in clearing P falciparum infection the three-drug combination is much less expensive is much more readily available at least for the foreseeable future and in West Africa resistance to both amodiaquine and sulfadoxine-pyrimethamine is relatively uncommon. Monotherapy for malaria is no longer acceptable and it is important to continue to consider effective combination antimalarials that may be alternatives to artemisinin-containing combinations. (excerpt)