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Artemisinin-based combination treatments (ACTs) are now generally accepted as the best treatments for uncomplicated falciparum malaria. They are rapidly and reliably effective. Efficacy is determined by the drug partnering the artemisinin derivative and, for artesunate–mefloquine, artemether–lumefantrine, and dihydroartemisinin–piperaquine, this usually exceeds 95%. Artesunate–sulfadoxine–pyrimethamine and artesunate–amodiaquine are effective in some areas, but in other areas resistance to the partner precludes their use. There is still uncertainty over the safety of artemisinin derivatives in the first trimester of pregnancy, when they should not be used unless there are no effective alternatives. Otherwise, except for occasional hypersensitivity reactions, the artemisinin derivatives are safe and remarkably well tolerated. The adverse effect profiles of the artemisinin-based combination treatments are determined by the partner drug. Most malaria endemic countries have now adopted artemisinin-based combination treatments as first-line treatment of falciparum malaria, but in most of these only a minority of the patients that need artemisinin-based combination treatments actually receive them.
Received February 5, 2007. Accepted for publication July 22, 2007.
Acknowledgments: FN and NW are both supported by the Wellcome Trust.
* Address correspondence to Nicholas White, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand. E-mail: nickw{at}tropmedres.ac
Authors’ addresses: Nicholas White, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand, Tel: (66) 2 354 9172, Fax: (66) 2 354 9169, E-mail: nickw{at}tropmedres.ac. François Nosten, Centre for Tropical Medicine and Vaccinology, Churchill Hospital, Oxford, UK, E-mail: SMRU{at}tropmedres.ac
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