Page 165 - 80 guidelines for the treatment of malaria_opt

ANNEX 7. Uncomplicated Plasmodium falciparum malaria

Serious indirectness: only one trial was conducted in Africa (Rwanda, transmission intensity not reported) and one in Asia (Indonesia, unstable transmission); children aged <1 year and pregnant

No serious limitations: allocation concealment was adequate in all trials that reported this outcome; laboratory staff were blinded in all trials.
or lactating women were excluded; due to variable resistance rates to amodiaquine, extrapolation to other areas is likely to be unreliable.
No serious imprecision: the 95% CI of the pooled estimate includes appreciable and non-appreciable benefit with DHA+PPQ over AS+AQ.
In these trials, both drugs have total failure rates (PCR adjusted) at day 28 of less than 10% in line with WHO

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).
DHA+PPQ is at least as effective at treating P. falciparum as AS+AQ (moderate quality evidence).
One trial (18) also reported outcomes at day 42 but losses to follow-up were very high (>20%) at this point in time.
Very serious imprecision: the 95% CI is wide including appreciable benefit or harm with each drug over the other.
Both trials report that there were no significant differences in gametocyte carriage, but figures were not given.

A7

recommendations. No serious inconsistency: heterogeneity was low. Serious indirectness: only one trial (18) assessed this outcome. Serious limitations: this trial was open label with no blinding of staff or participants.

panel comment: panel conclusion: Indonesia (18) and Rwanda (3).

10.
11.
8.
9.
3.
2.
1.
4.
7.
6.
5.

151