Addition of artesunate to standard antimalarial drugs reduces treatment failure

Question

What is the effect of adding artesunate to existing drug regimens for people with acute uncomplicated Plasmodium falciparum malaria?

Study design

Systematic review with meta-analysis.

Main results

16 trials met inclusion criteria. Standard antimalarial drugs in the trials varied (sulfadoxine–pyrimethamine: 7 RCTs; amodiaquine: 3 RCTs; chloroquine: 3 RCTs; mefloquine: 3 RCTs). Adding artesunate for 3 days to standard antimalarial drugs significantly reduced 14 and 28 day's failure rates compared with standard drugs alone (15 RCTs; OR for failure by 14 day 0.20, 95% CI 0.17 to 0.25; OR for failure by 28 days 0.23, 95% CI 0.19 to 0.28). Addition of artesunate for 1 day was not as effective as 3 days, but still significantly reduced failure rates compared with standard drugs alone (6 RCTs; OR for failure by 14 days 0.61, 95% CI 0.48 to 0.77; OR for failure by 28 days 0.68, 95% CI 0.53 to 0.89). The incidence of side effects was similar in both groups.

Authors’ conclusions

Adding artesunate to a standard antimalarial drug regimen for 3 days leads to a consistent decrease in treatment failure at 14 days, irrespective of the standard antimalarial drug used.