Scientists have come up with a new combination therapy for the treatment of malaria and preventing the parasite from becoming resistant.
For some time now, artemisinin, derived from a Chinese herb, has been the most powerful treatment available against malaria and the World Health Organisation (WHO) has strongly recommended combining artemisinin with another anti-malarial drug.
Following the WHO recommendation, scientists from the Institute of Tropical Medicine (ITM) carried out a head-to-head comparison of four combination therapies in seven African countries. One combination appeared particularly promising for regions where the risk of re-infection is high.
In recent years, the burden of malaria has declined substantially in several sub-Saharan African countries, due to large scale indoor residual spraying of insecticides, massive distribution of insecticide-treated bed nets, and the introduction of artemisinin-based combination treatments (ACTs).
To treat patients with malaria the WHO advises each region to choose an ACT based on the local level of resistance to non-artemisinin medicine in the combination. But data on that resistance is scarce.
The scientists, who also took part in the recent trials of the first effective malaria vaccine, compared four ACT treatments, in more than 4 000 randomised children less than 5 years of age with uncomplicated malaria, in twelve sites distributed in seven sub-Saharan African countries.
Three of the regimes had excellent and similar efficacy in treating the malaria attack, but of those, treatment with combination dihydroartemisinin-piperaquine (the combination most recent recommended by the WHO) resulted in significantly fewer recurrent infections.
The development of resistance should be closely monitored, the scientists advise, but this new therapy clearly shows great promise.