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Dihydroartemisinin-piperaquine versus artesunate-amodiaquine: Superior efficacy and posttreatment prophylaxis against multidrug-resistant Plasmodium falciparum and Plasmodium vivax malaria

Hasugian, A. R., Purba, H. L. E., Kenangalem, Enny, Wuwung, R. M., Ebsworth, E. P., Maristela, R., Penttinen, P. M. P., Laihad, F., Anstey, Nicholas M., Tjitra, E. and Price, Ric N. (2007). Dihydroartemisinin-piperaquine versus artesunate-amodiaquine: Superior efficacy and posttreatment prophylaxis against multidrug-resistant Plasmodium falciparum and Plasmodium vivax malaria. Clinical Infectious Diseases,44(8):1067-1074.

Document type: Journal Article
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Title Dihydroartemisinin-piperaquine versus artesunate-amodiaquine: Superior efficacy and posttreatment prophylaxis against multidrug-resistant Plasmodium falciparum and Plasmodium vivax malaria
Author Hasugian, A. R.
Purba, H. L. E.
Kenangalem, Enny
Wuwung, R. M.
Ebsworth, E. P.
Maristela, R.
Penttinen, P. M. P.
Laihad, F.
Anstey, Nicholas M.
Tjitra, E.
Price, Ric N.
Journal Name Clinical Infectious Diseases
Publication Date 2007
Volume Number 44
Issue Number 8
ISSN 1058-4838   (check CDU catalogue  open catalogue search in new window)
Start Page 1067
End Page 1074
Total Pages 8
Place of Publication Chicago
Publisher University of Chicago Press
HERDC Category C1 - Journal Article (DEST)
Abstract Background. Antimalarial drug resistance is now well established in both Plasmodium falciparum and Plasmodium vivax. In southern Papua, Indonesia, where both strains of plasmodia coexist, we have been conducting a series of studies to optimize treatment strategies. Methods. We conducted a randomized trial that compared the efficacy and safety of dihydroartemisininpiperaquine (DHP) with artesunate-amodiaquine (AAQ). The primary end point was the overall cumulative parasitological failure rate at day 42. Results. Of the 334 patients in the evaluable patient population, 185 were infected with P. falciparum, 80 were infected with P. vivax, and 69 were infected with both species. The overall parasitological failure rate at day 42 was 45% (95% confidence interval [CI], 36%-53%) for AAQ and 13% (95% CI, 7.2%-19%) for DHP (hazard ratio [HR], 4.3; 95% CI, 2.5-7.2;). Rates of both recrudescence of P. falciparum infection and recurrence P. vivax of P. vivax infection were significantly higher after receipt of AAQ than after receipt of DHP (HR, 3.4 [95% CI, 1.2-9.4] and 4.3 [95% CI, 2.2-8.2], respectively;). By the end of the study, AAQ recipients were 2.95-fold (95% CI, 1.2- to 4.9-fold) more likely to be anemic and 14.5-fold (95% CI, 3.4- to 61-fold) more likely to have carried P. vivax gametocytes. Conclusions. DHP was more effective and better tolerated than AAQ against multidrug-resistant P. falciparum and P. vivax infections. The prolonged therapeutic effect of piperaquine delayed the time to P. falciparum reinfection, decreased the rate of recurrence of P. vivax infection, and reduced the risk of P. vivax gametocyte carriage and anemia.
Keywords artemisinin
children
chloroquine
indonesia
mefloquine
papua
population
sulfadoxine-pyrimethamine
thailand
DOI http://dx.doi.org/10.1086/512677   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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