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Guidelines for the treatment of malaria – 2 edition

ANNEX 7
uncomplicated PlasmODium falciParum malaria

The GRADE tables in this section are based on the Cochrane review titled Artemisinin-
based combination therapies for treating uncomplicated malaria published in 2009 (1).
This review was used to answer specific questions (relating to the current use of ACTs)
for the WHO Expert Committee on Malaria. Evidence on the effectiveness of artemether
plus lumefantrine in Africa, artesunate plus amodiaquine in Africa and artesunate plus
mefloquine in Asia and South America is not presented here, as there were no new questions
surrounding their use. An outline of the methodology of this review is given below.
Objective

To compare the effects of ACTs with other available ACT and non-ACT antimalarial
combinations for treating uncomplicated P. falciparum malaria. This review was limited
to ACTs for which co-formulated products are currently available or shortly to be made
available. The included drugs were: dihydroartemisinin plus piperaquine; artesunate
plus mefloquine; artemether plus lumefantrine (six doses); artesunate plus amodiaquine,
artesunate plus sulfadoxine-pyrimethamine and amodiaquine plus sulfadoxine-
pyrimethamine.
search methods

A search was conducted in August 2008 of The Cochrane Infectious Disease Group
Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT), using
“malaria” and “arte*” or “dihydroarte*” as search terms.

inclusion criteria
Randomized head-to-head comparative trials of ACTs in the treatment of microscopically
confirmed, uncomplicated P. falciparum malaria in adults and children.

Data collection and analysis
Two authors independently assessed trials for eligibility, risk of bias and extracted data.
Primary outcome data was analysed in line with WHO’s protocol for the Assessment and
monitoring antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria
(2003) and drugs compared using risk ratios and 95% confidence intervals. Secondary
outcomes were effects on P. vivax, gametocytes, haemoglobin and adverse events.

results
A total of 47 trials met the inclusion criteria. All five ACT combinations were shown to
have failure rates of < 10% in line with WHO recommendations.
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