Artemisinin-based combination therapy for treating uncomplicated Plasmodium vivax malaria
Artemisinin-based combination therapy (ACT) for treating non-severe malaria due to Plasmodium vivax
Nithya Gogtay1, Sridharan Kannan2,Urmila M Thatte2,Piero L Olliaro3,David Sinclair4,*
1 Seth GS Medical College and KEM Hospital, Mumbai, India
2 Seth GS Medical College & KEM Hospital, Department of Clinical Pharmacology, Mumbai, Maharashtra, India
3 World Health Organization, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
4 Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
Artemisinin-based combination therapy for treating uncomplicated Plasmodium vivax malaria. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD008492.
To read the full review please follow this link: DOI: 10.1002/14651858. CD008492.pub3.
What is P. vivax malaria and how do ACTs work?
P. vivax is one of five species of the malaria parasite known to cause clinical illness. It is a common cause of malaria in Asia, South America and Oceania. Unlike P. falciparum (the commonest cause of malaria in Africa), P. vivax has a liver stage which is not treated by most common antimalarial drugs. This liver stage can become active and cause a relapse of clinical illness weeks or even years after the initial illness.
The standard treatment for vivax malaria has been chloroquine to treat the clinical illness, and a 14-day course of primaquine to clear the liver stage. In some parts of Oceania the P. vivax parasite in now highly resistant to chloroquine, which makes this treatment ineffective.
Artemisinin-based combination therapies (ACTs) are now the recommended treatment for P. falciparum malaria worldwide. As the effectiveness of chloroquine for P. vivax declines, alternative therapies are needed. If ACTs are also effective against P. vivax they could become the standard treatment for all forms of malaria.
Current ACT combinations do not contain drugs effective against the liver stage of P. vivax so primaquine would still be necessary to achieve complete cure.
What the research says about the effect of using ACTs
We examined the research published up to 28 March 2013.
Compared to chloroquine
People who are treated with an ACT are probably less likely to have another episode of P. vivax malaria during the next six to eight weeks than those treated with chloroquine (only dihydroartemisinin-piperaquine, artesunate plus sulphadoxine-pyrimethamine, and artesunate-pyronaridine have been compared with chloroquine). It is not clear whether this advantage is still present when primaquine is given to achieve a complete cure.
Compared to alternative ACTs
People who are treated with dihydroartemisinin-piperaquine are probably less likely to have another episode of P. vivax malaria during the next six weeks than those treated with alternative ACTs (only artemether-lumefantrine, artesunate plus sulphadoxine-pyrimethamine and artesunate plus amodiaquine have been compared). This advantage may be present even when additional primaquine is given to achieve a complete cure.