Volume 83, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) are highly efficacious antimalarial therapies in Africa. However, there are limited data regarding the tolerability of these drugs in young children. We used data from a randomized control trial in rural Uganda to compare the risk of early vomiting (within one hour of dosing) for children 6–24 months of age randomized to receive DP (n = 240) or AL (n = 228) for treatment of uncomplicated malaria. Overall, DP was associated with a higher risk of early vomiting than AL (15.1% versus 7.1%; = 0.007). The increased risk of early vomiting with DP was only present among breastfeeding children (relative risk [RR] = 3.35, = 0.001) compared with children who were not breastfeeding (RR = 1.03, = 0.94). Age less than 18 months was a risk factor for early vomiting independent of treatment (RR = 3.27, = 0.02). Our findings indicate that AL may be better tolerated than DP among young breastfeeding children treated for uncomplicated malaria.


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  1. Nosten F, White NJ, , 2007. Artemisinin-based combination treatment of falciparum malaria. Am J Trop Med Hyg 77: 181192. [Google Scholar]
  2. Olliaro P, Wells TN, , 2009. The global portfolio of new antimalarial medicines under development. Clin Pharmacol Ther 85: 584595.[Crossref] [Google Scholar]
  3. Arinaitwe E, Sandison TG, Wanzira H, Kakuru A, Homsy J, Kalamya J, Kamya MR, Vora N, Greenhouse B, Rosenthal PJ, Tappero J, Dorsey G, , 2009. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for falciparum malaria: a longitudinal, randomized trial in young Ugandan children. Clin Infect Dis 49: 16291637.[Crossref] [Google Scholar]
  4. Ratcliff A, Siswantoro H, Kenangalem E, Maristela R, Wuwung RM, Laihad F, Ebsworth EP, Anstey NM, Tjitra E, Price RN, , 2007. Two fixed-dose artemisinin combinations for drug-resistant falciparum and vivax malaria in Papua, Indonesia: an open-label randomised comparison. Lancet 369: 757765.[Crossref] [Google Scholar]
  5. Yeka A, Dorsey G, Kamya MR, Talisuna A, Lugemwa M, Rwakimari JB, Staedke SG, Rosenthal PJ, Wabwire-Mangen F, Bukirwa H, , 2008. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treating uncomplicated malaria: a randomized trial to guide policy in Uganda. PLoS ONE 3: e2390.[Crossref] [Google Scholar]
  6. Zwang J, Ashley EA, Karema C, D'Alessandro U, Smithuis F, Dorsey G, Janssens B, Mayxay M, Newton P, Singhasivanon P, Stepniewska K, White NJ, Nosten F, , 2009. Safety and efficacy of dihydroartemisinin-piperaquine in falciparum malaria: a prospective multi-centre individual patient data analysis. PLoS ONE 4: e6358.[Crossref] [Google Scholar]
  7. Leonardi E, Gilvary G, White NJ, Nosten F, , 2001. Severe allergic reactions to oral artesunate: a report of two cases. Trans R Soc Trop Med Hyg 95: 182183.[Crossref] [Google Scholar]
  8. ter Kuile FO, Nosten F, Luxemburger C, Kyle D, Teja-Isavatharm P, Phaipun L, Price R, Chongsuphajaisiddhi T, White NJ, , 1995. Mefloquine treatment of acute falciparum malaria: a prospective study of non-serious adverse effects in 3673 patients. Bull World Health Organ 73: 631642. [Google Scholar]
  9. Bukirwa H, Nayiga S, Lubanga R, Mwebaza N, Chandler C, Hopkins H, Talisuna AO, Staedke SG, , 2008. Pharmacovigilance of antimalarial treatment in Uganda: community perceptions and suggestions for reporting adverse events. Trop Med Int Health 13: 11431152.[Crossref] [Google Scholar]
  10. Price RN, Dorsey G, Nosten F, , 2009. Antimalarial therapies in children from Papua New Guinea. N Engl J Med 360: 1254, author reply 1255.[Crossref] [Google Scholar]
  11. Sim IK, Davis TM, Ilett KF, , 2005. Effects of a high-fat meal on the relative oral bioavailability of piperaquine. Antimicrob Agents Chemother 49: 24072411.[Crossref] [Google Scholar]
  12. Borrmann S, Sallas WM, Machevo S, Gonzalez R, Bjorkman A, Martensson A, Hamel M, Juma E, Peshu J, Ogutu B, Djimde A, D'Alessandro U, Marrast AC, Lefevre G, Kern SE, , 2010. The effect of food consumption on lumefantrine bioavailability in African children receiving artemether-lumefantrine crushed or dispersible tablets (Coartem) for acute uncomplicated Plasmodium falciparum malaria. Trop Med Int Health 15: 434441. [Google Scholar]
  13. ter Kuile FO, Luxemburger C, Nosten F, Thwai KL, Chongsuphajaisiddhi T, White NJ, , 1995. Predictors of mefloquine treatment failure: a prospective study of 1590 patients with uncomplicated falciparum malaria. Trans R Soc Trop Med Hyg 89: 660664.[Crossref] [Google Scholar]

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  • Received : 13 Mar 2010
  • Accepted : 20 Jul 2010
  • Published online : 05 Oct 2010

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