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Research comparing the effectiveness of three leading antimalarial combination therapies in East Africa has found one to be much more effective than the others.

Combination therapy is currently considered to be the best first-line treatment for malaria in Africa, write the researchers. But until now, it has been unclear which treatment was the most effective.

The researchers — led by Grant Dorsey of the University of California in the United States — randomised 329 Ugandan children between 1-10 years with malaria to receive one of the three leading combination therapies.

The research showed that treatment with a combination of artemether and lumefantrine had the lowest risk of failure — where failure is defined as either the presence of malaria symptoms or the malaria parasite in the body 28 days after treatment.

Treatment failed in just 6.7 per cent of children treated with artemether-lumefantrine, compared with 17.4 per cent treated with amodiaquine plus artesunate and 26.1 per cent for amodiaquine plus sulfadoxine-pyrimethamine.

All three therapies used in the study were well tolerated by the children.

Efficacy research into combination therapies is timely, as malaria is becoming increasingly resistant to many conventional anti-malarial drugs such as chloroquine and sulfadoxine-pyrimethamine, a situation that has led to a shift from single to combination therapies.

Willis Akhwale, director of Kenya's Division of Malaria Control, says the Ugandan research will be a "key pointer" for African governments, and reflects the position Kenya adopted a year ago.

Faced with increasing resistance to sulfadoxine-pyrimethamine — a commonly used single-drug treatment — the Kenyan government decided to introduce artemether-lumefantrine combination therapy to all public hospitals and clinics, he says.

"We needed to introduce a drug with a quick parasite clearance with no known resistance. We have been following up on [artemether-lumefantrine] which we have prescribed in public hospitals for over six months and I can say we haven't seen any adverse effects," Akhwale told

The researchers emphasise that the results are specific to East Africa — where drug resistance is the highest in Africa — and that other combination therapies may work better in other areas with different drug resistance patterns.

"Antimalarial regimens must be tailored according the local drug-sensitivity patterns," they write.

The research was published in the May 23-30 issue of the Journal of the American Medical Association.

Link to full paper in the Journal of the American Medical Association

Reference: Journal of the American Medical Association 297, 2210 (2007)

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