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Study Reveals Best Drug Combinations for Treating Malaria in Myanmar NEW YORK -- September 8, 2010 -- All of the currently available fixed-dose artemisinin combination treatments (ACTs) for falciparum malaria are highly effective in Myanmar (Burma), providing rapid parasite clearance and cure rates greater than 95%, with the exception of artesunate-amodiaquine, which should not be used as a first-line treatment in Myanmar. Moreover, the addition of a single dose of primaquine to ACT regimens was well tolerated and would substantially reduce transmission potential. These results are published online first and will appear in the November print issue of The Lancet Infectious Diseases. Frank Smithuis, MD, Médecins Sans Frontières, Amsterdam, the Netherlands, and Nicholas White, MD, Mahidol University, Bangkok, Thailand, and colleagues recruited 808 adults and children with uncomplicated falciparum malaria from 3 clinics in Myanmar. Patients were randomly allocated to receive 1 of 4 fixed-dose ACTs; artesunate-amodiaquine (n = 155), artemether-lumefantrine (n = 162), artesunate-mefloquine (n = 169), loose artesunate-mefloquine (n = 161) or dihydroartemisinin-piperaquine (n = 161). All patients were also randomised to receive either a single dose of primaquine or not. Patients were followed up for 63 days, and time to recurrence of malaria after treatment was recorded. The artesunate-amodiaquine regimen had the lowest cure rate and the highest rate of reinfection and was not effective enough to be recommended as a first-line treatment. All the other drug combinations were substantially more effective with cure rates greater than 95%. The regimens were all well tolerated, and most side-effects were mild and did not substantially affect adherence to treatment. Overall, the artesunate-mefloquine fixed-dose regimen had fewer recurrences of falciparum malaria, the highest cure rates, and lowest rates of gametocyte carriage. Without primaquine the ACT regimens had wide variations in gametocytocidal activity. The addition of a single dose of primaquine almost completely eliminated the risk of gametocyte carriage for all the ACT regimens, removing any differences in the transmission-blocking action. "The addition of a single gametocytocidal dose of primaquine was well tolerated and highly effective and did not cause any serious adverse effects…[and] could have a major effect on malaria transmission from treated patients and could have a crucial role in elimination programmes," the authors wrote. SOURCE: The Lancet Infectious Diseases E-mail this page to a friend or colleague! To print, use this version