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Optimal dosing of dihydroartemisinin-piperaquine for seasonal malaria chemoprevention in young children
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Optimal dosing of dihydroartemisinin-piperaquine for seasonal malaria chemoprevention in young children
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Journal Article
Optimal dosing of dihydroartemisinin-piperaquine for seasonal malaria chemoprevention in young children
2019
Overview
Young children are the population most severely affected by
Plasmodium falciparum
malaria. Seasonal malaria chemoprevention (SMC) with amodiaquine and sulfadoxine-pyrimethamine provides substantial benefit to this vulnerable population, but resistance to the drugs will develop. Here, we evaluate the use of dihydroartemisinin-piperaquine as an alternative regimen in 179 children (aged 2.33–58.1 months). Allometrically scaled body weight on pharmacokinetic parameters of piperaquine result in lower drug exposures in small children after a standard mg per kg dosage. A covariate-free sigmoidal
E
MAX
-model describes the interval to malaria re-infections satisfactorily. Population-based simulations suggest that small children would benefit from a higher dosage according to the WHO 2015 guideline. Increasing the dihydroartemisinin-piperaquine dosage and extending the dose schedule to four monthly doses result in a predicted relative reduction in malaria incidence of up to 58% during the high transmission season. The higher and extended dosing schedule to cover the high transmission period for SMC could improve the preventive efficacy substantially.
Seasonal malaria chemoprevention provides substantial benefit for young children, but resistance to used drugs will likely develop. Here, Chotsiri et al. evaluate the use of dihydroartemisinin-piperaquine as a regimen in 179 children, and population-based simulations suggest that small children would benefit from a higher and extended dosage.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ Antimalarials - administration & dosage
/ Antimalarials - pharmacokinetics
/ Artemisinins - administration & dosage
/ Artemisinins - pharmacokinetics
/ Children
/ Dosage
/ Female
/ Humanities and Social Sciences
/ Humans
/ Malaria
/ Malaria, Falciparum - prevention & control
/ Male
/ Quinolines - administration & dosage
/ Quinolines - pharmacokinetics
/ Science
/ Seasons
