Malaria treatment could improve in children

December 3, 2013, Public Library of Science

An analysis of patients from across the malaria endemic world suggests that a key antimalarial treatment could be improved by better dosing in young children.

Antimalarial has hampered programs for almost 60 years. A key factor in combatting this threat is to ensure that all are deployed in a way that ensures that the maximum number of patients are completely cured.

A study published this week in PLOS Medicine explores this issue by presenting the results of a large pooled analysis of more than 7,000 patients with malaria from Africa, Asia and South America. It presents a convincing argument for public health policy-makers to pay careful attention to dosing recommendations for artemisinin combination therapies (ACTs) when reviewing current drug protocols, particularly for .

The paper examines the combination of piperaquine and dihydroartemisinin, an increasingly common choice of treatment for patients suffering from malaria caused by the malaria parasite Plasmodium falciparum.

The results of the study, coordinated by the WorldWide Antimalarial Resistance Network (WWARN), show that while treatment of malaria with dihydroartemisinin-piperaquine generally results in excellent patient recovery, young children are at higher risk of treatment failure and this may be due to their receiving an insufficient dose of the drug.

WWARN brought together 76 researchers worldwide who contributed individual patient data from 26 clinical studies. These data are being used to analyze the implications of different drug dosing levels of ACTs, for treatment efficacy. The results, which combine almost 70% of all available published data on this treatment, confirm that dihydroartemisinin-piperaquine is highly efficacious curing more than 97% of patients.

However, the study also highlights that one third of children aged 1-5 years received a dose of piperaquine below that recommended by the World Health Organisation. Furthermore, patients receiving a lower dose were slower to respond to treatment and had a greater risk of getting again.

Dr Corine Karema, from the Rwandan National Malaria Control Program and a co-author of the paper, emphasises that "It is very important that treatment guidelines recommend optimal drug dosing levels to maximise their impact and ensure all patients are rapidly and completely cured."

The results suggest that further drug dose optimization of dihydroartemisinin-piperaquine may be warranted in young children.

Professor Ric Price, one of the lead investigators working with WWARN, concludes "This study highlights the ability of researchers from around the world to come together and pool their data for collective gain. The power of such research collaborations will help to support the optimisation of current antimalarial treatments, reduce the spread of antimalarial drug resistance and ultimately save lives"

In a linked Perspective, Paul Garner, from the Liverpool School of Tropical Medicine, UK, discusses some of the issues associated with optimizing ACT dosing.

He says: "There is a balancing act between under-dosing, which increases the risk of resistance developing, and increasing dosing such that toxicity and adverse events increase."

Explore further: Study is first to explain type of antimalarial drug resistance

More information: The WorldWide Antimalarial Resistance Network (WWARN) DP Study Group (2013) The Effect of Dosing Regimens on the Antimalarial Efficacy of Dihydroartemisinin-Piperaquine: A Pooled Analysis of Individual Patient Data. PLoS Med 10(12): e1001564. DOI: 10.1371/journal.pmed.1001564

Related Stories

Study is first to explain type of antimalarial drug resistance

November 20, 2013
A Georgetown University professor published in the online journal PLOS ONE the first study explaining why drugs designed to fight off malaria stop working in some people with the disease.

Low-dose treatment may block malaria transmission

November 14, 2013
Lower doses of the antimalarial drug primaquine are as effective as higher doses in reducing malaria transmission, according to a study published today in Lancet Infectious Diseases by London School of Hygiene & Tropical ...

New artemisinin-based treatment against malaria promising

November 8, 2011
For some time now, artemisinin, derived from a Chinese herb, has been the most powerful treatment available against malaria. To avoid the malaria parasite becoming resistant, the World Health Organisation (WHO) strongly recommends ...

$450 mn needed to tackle 'grave' malaria threat, WHO says

October 24, 2013
Hundreds of millions of dollars are needed to stop a deadly form of drug-resistant malaria jumping from Southeast Asia to the rest of the world, the World Health Organisation said Thursday.

Recommended for you

Fresh approach to tuberculosis vaccine offers better protection

January 17, 2018
A unique platform that resulted in a promising HIV vaccine has also led to a new, highly effective vaccine against tuberculosis that is moving toward testing in humans.

Study reveals how MRSA infection compromises lymphatic function

January 17, 2018
Infections of the skin or other soft tissues with the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function. ...

Newly-discovered TB blood signal provides early warning for at-risk patients

January 17, 2018
Tuberculosis can be detected in people with HIV infection via a unique blood signal before symptoms appear, according to a new study by researchers from the Crick, Imperial College London and the University of Cape Town.

New study validates clotting risk factors in chronic kidney disease

January 17, 2018
In late 2017, researchers from Boston University School of Medicine (BUSM) discovered and published (Science Translational Medicine, (9) 417, Nov 2017) a potential treatment target to prevent chronic kidney disease (CKD) ...

New study offers insights on genetic indicators of COPD risk

January 16, 2018
Researchers have discovered that genetic variations in the anatomy of the lungs could serve as indicators to help identify people who have low, but stable, lung function early in life, and those who are particularly at risk ...

Previous influenza virus exposures enhance susceptibility in another influenza pandemic

January 16, 2018
While past exposure to influenza A viruses often builds immunity to similar, and sometimes different, strains of the virus, Canadian researchers are calling for more attention to exceptions to that rule.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.