Artemisinin-based combination therapies (ACTs) are the cornerstone for the treatment of malaria. However, confirmed\nresistance to artemisinins in South-East Asia, and reports of reduced efficacy of ACTs raise major concerns for malaria\ntreatment and control. Without new drugs to replace artemisinins, it is essential to define dosing strategies that\nmaximize therapeutic efficacy, limit the spread of resistance, and preserve the clinical value of ACTs. It is important to\ndetermine the extent to which reduced efficacy of ACTs reflects true resistance versus sub-optimal dosing, and quantify\nother factors that determine treatment failure. Pooled analyses of individual patient data from multiple clinical trials, by\ninvestigators in the Worldwide Antimalarial Resistance Network, have shown high overall efficacy for three widely used\nACTs, artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine. Analyses also highlight\nthat suboptimal dosing leads to increased risk of treatment failure, especially among children. In the most recent\nstudy, an analysis of clinical trials of artesunate-amodiaquine, widely used among children in Africa, revealed a\nsuperior efficacy for fixed-dose combination tablets compared to loose non-fixed dose combinations. This highlights\nthe benefits of fixed-dose combinations as a practical strategy for ensuring optimal antimalarial dosing and\nmaximizing efficacy.
Loading....