Artemether‐lumefantrine (regimen enam‐dos) untuk merawat malaria falciparum tidak berkomplikasi
Abstract
Background
Using a pilot system we have categorised this review as: Current question ‐ no update intended (topic covered in another review. Refer to: Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin‐based combination therapy for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2.) Please see "Published notes" section of the review for more details.
The World Health Organization recommends artemether‐lumefantrine for treating uncomplicated malaria. We sought evidence of superiority of the six‐dose regimen over existing treatment regimens as well as its effectiveness in clinical situations.
Objectives
To evaluate the six‐dose regimen of artemether‐lumefantrine for treating uncomplicated falciparum malaria.
Search methods
We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), conference proceedings, and reference lists of articles. We also contacted experts in malaria research and the pharmaceutical company that manufactures artemether‐lumefantrine.
Selection criteria
Randomized controlled trials comparing six doses of artemether‐lumefantrine administered orally with standard treatment regimens (single drug or combination), or supervised with unsupervised treatment, for uncomplicated falciparum malaria.
Data collection and analysis
Two authors independently applied inclusion criteria to potentially relevant trials, assessed the risk of bias in the trials, and extracted data, including adverse events. Total failure by day 28 (day 42 for sulfadoxine‐pyrimethamine and day 63 for mefloquine) was the primary outcome.
Main results
Nine trials (4547 participants) tested the six‐dose regimen. Total failure at day 28 for artemether‐lumefantrine was lower when compared with amodiaquine (270 participants, 1 trial), amodiaquine plus sulfadoxine‐pyrimethamine (507 participants, 1 trial), but not with chloroquine plus sulfadoxine‐pyrimethamine (201 participants, 2 trials). In comparisons with artemisinin derivative combinations, artemether‐lumefantrine performed better than amodiaquine plus artesunate (668 participants, 2 trials), worse than mefloquine plus artesunate (270 participants, 4 trials), and no differently to dihydroartemisinin‐napthoquine‐trimethoprim (89 participants, 1 trial).
Authors' conclusions
The six‐dose regimen of artemether‐lumefantrine appears more effective than antimalarial regimens not containing artemisinin derivatives.
PICO
Plain language summary
Artemether‐lumefantrine (regimen enam‐dos) untuk merawat malaria tidak berkomplikasi
Dengan menggunakan sistem perintis kita ini, ulasan ini telah dikategorikan sebagai: soalan semasa ‐ Kemaskini tidak bertujuan (topik diliputi dalam kajian yang lain. Rujuk: Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Terapi kombinasi berasaskan artemisinin untuk merawat malaria tidak berkomplikasi. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2.) Sila lihat bahagian "Nota‐Nota terbitan" ulasan untuk maklumat lanjut.
Malaria adalah penyakit parasit yang disebarkan oleh nyamuk. Ia menjejas berjuta‐juta orang di seluruh dunia dan merupakan punca utama penyakit dan kematian. Malaria tidak berkomplikasi membentangkan simptom‐simptom seperti demam, sakit kepala, sakit otot, dan muntah‐muntah. Parasit ini telah menjadi rintang terhadap beberapa ubat‐ubatan yang sebelum ini efektif, dan jadi kombinasi ubat‐ubatan telah digunakan untuk cuba mengubati dan menghalang rintangan yang seterusnya. Artemether‐lumefantrine adalah satu kombinasi ubat‐ubatan tersebut. Ulasan ujian‐ujian ini menunjukkan bahawa regimen enam‐dos dari artemether‐lumefantrine dikaitkan dengan kadar penyembuhan yang tinggi dan lebih berkesan berbanding dengan kebanyakan kombinasi ubat lain untuk malaria tidak berkomplikasi. Penyelidikan lanjutan diperlukan untuk menilai kesan sampingan buruk dengan betul.
