Open label randomized comparison of dihydroartemisinin–piperaquine and artesunate–amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in central Vietnam

Summary Objective Artesunate–amodiaquine (AAQ) is efficacious for the treatment of uncomplicated Plasmodium falciparum malaria in Africa, but little is known about its efficacy in Southeast Asia. We compared the efficacy of dihydroartemisinin–piperaquine (DHP) and AAQ against falciparum malaria in central Vietnam. Methods Open, randomized clinical trial of 116 patients (36 children aged 6–14 years, 80 adults aged 15–60 years) were randomly allocated a 3‐day course of either DHP (∼2.3 mg/kg dihydroartemisinin plus ∼18.5 mg/kg of piperaquine per day) or AAQ (∼4.4 mg/kg of artesunate plus ∼10.6 mg/kg of amodiaquine per day). The follow‐up period was 42 days. Results The two drug combinations were well tolerated by all age groups with no obvious drug associated adverse events. Of the patients who completed 42 days of follow‐up, 49 were on DHP (15 children, 34 adults) and 49 were on AAQ (14 children, 35 adults). The 42 day cure rates adjusted for reinfection identified by PCR genotyping for the two groups were similar [100% (49/49) and 98% (48/49) for DHP and AAQ, respectively]. With fewer reinfections, DHP appears to possess greater post‐treatment prophylactic activity than AAQ. Conclusion AAQ, an inexpensive artemisinin‐based combination, could be an additional option to DHP for the treatment of multidrug‐resistant falciparum malaria in Vietnam.