Page 151 - 80 guidelines for the treatment of malaria_opt

ANNEX 7. Uncomplicated Plasmodium falciparum malaria

No serious limitations: allocation concealment was judged to be at “low risk of bias” in all trials that reported this outcome; laboratory staff were blinded to treatment allocation in one trial.

Trials conducted in Burkina Faso (holoendemic) and Rwanda (transmission not stated); children aged <6 months and pregnant or lactating women were excluded.
In one of these two trials (Rwanda), the total failure rate (PCR adjusted) with AQ+SP exceeded the maximum 10% that WHO recommends.

Very serious imprecision: no events were recorded; it is unlikely that trials of this size would detect rare but important serious adverse events.

Serious indirectness: due to variable resistance rates to AQ and SP, extrapolation of results to other areas is likely to be unreliable.
No serious imprecision: both limits of the 95% CI of the pooled estimate imply appreciable benefit with DHA+PPQ over AQ+SP.
DHA+PPQ is more effective than AQ+SP at treating P. falciparum malaria (moderate quality evidence).
Please note that due to its longer half-life, treatment failure with DHA+PPQ may be underestimated at this point in time.
No difference has been shown in the incidence of serious adverse events (very low quality evidence).
One trial (2) reports vomiting medication on day 0 (as an exclusion criteria not an outcome) and found no difference.
10. Very serious imprecision: the 95% CI is wide including appreciable benefit or harm with each drug over the other.
No difference has been shown in the effect on gametocytes (very low quality evidence).

A7

Burkina Faso (2) and Rwanda (3). One trial (2) also reported treatment failure at day 42 and did not show a difference. No serious inconsistency: heterogeneity was low. No serious limitations: allocation concealment was adequate; the trial was unblinded. Serious indirectness: only one trial reported this outcome (2).

panel comment: panel conclusion:

11.
12.
13.
9.
3.
4.
1.
2.
7.
8.
5.
6.

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