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

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 se...

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Bibliographic Details
Published in:PloS one 2013-01, Vol.8 (1), p.e53772
Main Authors: Yeka, Adoke, Tibenderana, James, Achan, Jane, D'Alessandro, Umberto, Talisuna, Ambrose O
Format: Article
Language:English
Subjects:
Antimalarials - adverse effects
Antimalarials - therapeutic use
Artemether
Artemisinin
Artemisinins - adverse effects
Artemisinins - therapeutic use
Biology
Child, Preschool
Children
Clinical trials
Dihydroartemisinin
Disease transmission
Drug therapy
Effectiveness
Ethanolamines - adverse effects
Ethanolamines - therapeutic use
Fluorenes - adverse effects
Fluorenes - therapeutic use
Health risks
Humans
Infant
Infection
Infections
Malaria
Malaria, Falciparum - drug therapy
Male
Medical law
Medicine
Patients
Plasmodium falciparum
Quinine
Quinine - adverse effects
Quinine - therapeutic use
Quinolines - adverse effects
Quinolines - therapeutic use
Recurrent infection
Safety
Statistical analysis
Surveillance
Therapy
Treatment Outcome
Uganda
Vector-borne diseases
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Summary: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. 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. 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
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0053772