Artemisinin-naphthoquine for treating uncomplicated Plasmodium falciparum malaria


Rachel Isba1, Babalwa Zani2, Michael Gathu3, David Sinclair1, 

1. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
2. South African Medical Research Council, South African Cochrane Centre, Cape Town, Western Cape, South Africa 
3. KEMRI-Wellcome Trust Research Programme, Health Services Unit, Nairobi, Kenya

 Isba R, Zani B, Gathu M, Sinclair D. Artemisinin-naphthoquine for treating uncomplicatedPlasmodium falciparum malaria. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD011547. DOI: 10.1002/14651858.CD011547.

To read the full review please follow this link: DOI: 10.1002/14651858.CD011547

 This Cochrane Review summarises trials evaluating the effects of artemisinin-naphthoquine compared to other artemisinin-based combination therapies (ACTs) recommended by the World Health Organization (WHO) for treating adults and children with uncomplicatedP. falciparum malaria. After searching for relevant trials up to January 2015, we included four randomized controlled trials, enrolling 740 adults and children.

 What is uncomplicated malaria and how might artemisinin-naphthoquine work

 Uncomplicated malaria is the mild form of malaria which usually causes a fever, with or without headache, tiredness, muscle pains, abdominal pains, nausea, and vomiting. If left untreated, uncomplicated malaria can develop into severe malaria with kidney failure, breathing difficulties, fitting, unconsciousness, and eventually death.

 The WHO recommends ACT for treating people with P. falciparum malaria. Five combinations are currently recommended, all administered over three days. Artemisinin-naphthoquine is a new combination developed in China, which is being marketed and evaluated as one-day or three-day regimens.

 What the research says

 Artemisinin-naphthoquine versus artemether-lumefantrine

 In three small trials from Benin, Côte d'Ivoire, and Papua New Guinea, both artemisinin-naphthoquine and AL had a very low incidence of treatment failure at Day 28 (low quality evidence), and in the trial from Papua New Guinea it remained low in both groups at Day 42 (very low quality evidence).

 Artemisinin-naphthoquine versus dihydroartemisinin-piperaquine

 In a single small study from Indonesia, treatment failure at Day 28 and Day 42 was very low with both artemisinin-naphthoquine and DHA-P (very low quality evidence).


 The results of these few trials of artemisinin-naphthoquine are promising, but larger trials from multiple settings are required to be confident that artemisinin-naphthoquine is as effective and well tolerated as other antimalarials.