Artesunate-clindamycin versus quinine-clindamycin in the treatment of Plasmodium falciparum malaria: a randomised controlled trial

Abstract number: 1133_120

Ramharter M., Oyakhirome S., Klein Klouwenberg P., Adegnika A.A., Agnandji S.T., Missinou M.A., Issifou S., Graninger W., Kremsner P.G.

Objective:  

Artemisinin based drug combinations are the mainstay in the fight against drug resistant malaria in Africa. Currently available antimalarial drug combinations including artemisinins are pharmacokinetically unmatched and are therefore potentially increasing the risk of selecting resistant mutants in areas of high malaria transmission. We aimed to test the potential value of short half-life artemisinin based combination therapy for uncomplicated falciparum malaria in sub-Saharan Africa.

Methods:  

We conducted an open label randomized controlled clinical trial to evaluate the efficacy and tolerability of 3 days twice daily, oral artesunate-clindamycin therapy (2 mg/kg and 7 mg/kg per dose) compared to a standard quinine-clindamycin regimen (15 mg/kg and 7 mg/kg per dose) in the treatment of uncomplicated falciparum malaria in 100 Gabonese children aged 3 to 12 years.

Results:  

Artesunate-clindamycin showed comparable activity to quinine-clindamycin in the per-protocol analysis of day-28 cure rates (87% versus 94%). No serious adverse events were reported and tolerability was similar in both groups. Fever and parasite clearance times were significantly shorter in the artesunate clindamycin group.

Conclusions:  

Artesunate-clindamycin and other matching short plasma half-life combinations of artemisinins merit further attention in regions with high malaria transmission.