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A comparison of the duration of post-treatment protection of artemether-lumefantrine, dihydroartemisinin-piperaquine and artesunate-amodiaquine for the treatment of uncomplicated malaria

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Five artemisinin combination therapies (ACTs) are currently recommended for treatment of uncomplicated malaria in Africa. Whilst the artemisinin component has a short half-life, the partner drugs give rise to differing durations of post-treatment prophylaxis, protecting from re-infection and reducing transmission. We compared the duration of post-treatment prophylaxis of artemether-lumefantrine (AL), dihydroartemisinin-piperaquine (DHA-PPQ) and artemisinine-amodiaquine (AS-AQ).

Materials and methods

We pooled the results from analyses of 6 trials (1651 individuals) of AL versus DHA-PPQ and from 18 trials (5060 individuals) of AL versus AS-AQ. The time to re-infection after treatment was used to estimate the duration of post-treatment protection accounting for the variation in transmission intensity between settings. This duration was then used in a mathematical model of malaria transmission to estimate the comparative public health impact of each drug used for 1st-line treatment in low, medium and high transmission settings.


We estimated a mean duration of post-treatment protection of 10.7 days (95% CI: 10.2-11.2) and 13.8 days (95% CI: 10.2-22.8) for AL from the two analyses, 29.4 days (95% CI: 16.4-48.8) for DHA-PPQ, and 11.8 days (95% CI: 11.0-12.5) for ASAQ. There was no substantial difference in the public health impact of using AL versus AS-AQ. Use of DHA-PPQ for 1st-line treatment averted 8.3 additional cases per 1,000 people (0.8% of all cases) over 5 years compared to AL or AS-AQ. This protective effect was stronger in areas of high transmission as well as in seasonal settings.


While it is important to maintain a diverse set of first-line treatments for uncomplicated malaria, our results suggest that partner drugs with a longer half-life could be beneficial in reducing repeat episodes and onward transmission, particularly in high and seasonal transmission areas.

Author information

Correspondence to Michael T Bretscher.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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  • Malaria
  • Malaria Transmission
  • High Transmission
  • Transmission Intensity
  • Uncomplicated Malaria


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