Artemisinin Combination Therapy: A Good Antimalarial, but Is the Dose Right?

Artemisinin combination therapy (ACT) has revolutionised malaria treatment. ACTs combine an artemisinin derivative (a relatively new group of very effective drugs [1]) with another longer-lasting drug from another class to try to reduce the risk of further resistance developing. ACTs cure over 90% of people; they also act against malaria gametocytes, so potentially reduce transmission [1]. In 2006, the World Health Organization (WHO) recommended ACTs for uncomplicated Plasmodium falciparum malaria worldwide [2]. In 2010, the WHO added dihydroartemisinin-piperaquine (DHA-PPQ) to their existing list of four recommended ACTs (that is, artemether-lumefantrine, artesunate-amodiaquine, artesunate-mefloquine, and artesunate-sulfadoxine-pyrimethamine). DHA-PPQ is clearly at least as good as existing options, and it has a simple dosing schedule of one dose daily for three days [3,4].