Fosmidomycin-piperaquine combo viable alternative to artemisinin for malaria
The fosmidomycin-piperaquine combination therapy appears to have high clinical efficacy and acceptable safety for the treatment of uncomplicated Plasmodium falciparum malaria, and may thus be considered a viable artemisinin substitute, a recent study shows.
The study included both adult and paediatric malaria patients with initial parasite counts between 1,000 and 150,000 per µL. All participants received 30 mg/kg of oral fosmidomycin twice daily and 16 mg/kg of oral piperaquine once daily for 3 days.
After 28 days of follow-up, all 83 participants had adequate clinical and parasitological response (ACPR). Two recorded treatment failures were identified as reinfections. Twelve late parasitological failures were reported but were identified as new infections. The resulting polymerase chain reaction-corrected ACPR rate at day 63 was 100 percent.
At day 7, all participants tested negative for malaria. The overall proportion of patients with gametocytes at days 0 and 7 were 5 and 3 percent, respectively. Rapid treatment response was reported in all participants.
Three adults and 49 children, who were anaemic at baseline, were observed to have increased haemoglobin levels 7 days after treatment. Five cases with baseline platelet counts of <100,000 mm3 showed normal levels by day 7. On the other hand, two patients experienced a reduction in haemoglobin level on day 3 but did not show any clinical consequences.
There was a total of 97 adverse events recorded, experienced by 55 patients. The majority of events were of the gastrointestinal tract and the upper and lower respiratory tract (24 percent for both). These were followed by skin lesions (13 percent), headaches and fevers (12 percent), anaemia (5 percent), and urogenital schistosomiasis infections (4 percent).