In this month's premier open-access journal PLoS Medicine Colin Sutherland and colleagues from the London School of Hygiene and Tropical Medicine report the results of a randomized, controlled trial of 497 children in Uganda treated with one of two leading combination therapies. One regimen was an artemisinin-based combination consisting of artemether and lumefantrine (co-artemether, trade names CoArtem and Riamet). The other was a combination of CQ and SP - currently under consideration in several African countries, largely due to its low cost. Altogether, the six-dose regimen of co-artemether was highly effective at reducing whether and how long children had gametocytes - the infective form of the malarial parasite - in their blood. The numbers of gametocytes carried and how able they were to infect mosquitoes 7 days later was also reduced by the six dose regimen.
Although the results are promising, some patients may have difficulty taking a six-dose regimen, and as it also needs oily food for adequate absorption there might be inadequate drug levels in the blood of many treated individuals. The authors conclude that although co-artemether as a first-line treatment is not likely to reduce overall transmission of Plasmodium falciparum w ithin the community it might reduce selective transmission of resistant parasites in treated patients.
Citation: Sutherland CJ, Ord R, Dunyo S, Jawara M, Drakeley CJ, et al. (2005) Reduction of malaria transmission to Anopheles mosquitoes with a six-dose regimen of coartemether. PLoS Med 2(4): e92.