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Guidelines for the treatment of malaria – 2 edition

In addition to the four ACT combinations – artemether plus lumefantrine (AL), artesunate
plus amodiaquine (AS+AQ), artesunate plus mefloquine (AS+MQ), and artesunate
plus sulfadoxine-pyrimethamine (AS+SP) – already recommended for the treatment
of uncomplicated P. falciparum malaria there is now sufficient evidence on safety and
efficacy of dihydroartemsinin plus piperaquine (DHA+PPQ) for its addition to the list
of ACTs options recommended for the treatment of uncomplicated falciparum malaria
(see Annex 7, Section A7.1).

box 7.3

recommendation: DHA+PPQ as a first-line treatment for uncomplicated P. falciparum malaria
 dHa+ppQ is an act option for first-line treatment of uncomplicated P. falciparum malaria
worldwide. Strong recommendation, high quality evidence
GraDE evaluation (see Annex 7, tables A7.3.1–A7.3.3)
In clinical trials directly comparing DHA+PPQ and the currently recommended ACTs, DHA+PPQ was at
least as effective at treating uncomplicated P. falciparum malaria (as measured by PCR adjusted treatment
failure) as:
• artesunate plus mefloquine in Asia (day 63, 3 trials, 1182 participants; RR 0.39, 95% CI 0.19–0.79;
high quality evidence);
• artemether plus lumefantrine worldwide (day 42, 4 trials, 1492 participants; RR 0.42, 95% CI 0.26–0.67;
high quality evidence);
• artesunate plus amodiaquine worldwide (day 28, 2 trials, 679 participants; RR 0.47, 95% CI 0.23–0.94;
moderate quality evidence).

Other considerations
At the time of publication, no DHA+PPQ product has been prequalified by WHO or registered by any
stringent medicine regulatory authority.

In summary, the ACT options now recommended for treatment of uncomplicated
falciparum malaria in alphabetical order are:
■ artemether plus lumefantrine,
■ artesunate plus amodiaquine,
■ artesunate plus mefloquine,
7
■ artesunate plus sulfadoxine-pyrimethamine,
■ dihydroartemisinin plus piperaquine.

7 A similar medicine with tablets containing 500 mg of sulfalene and 25 mg pyrimethamine is considered an
alternative to sulfadoxine-pyrimethamine.
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