Emergence of Plasmodium falciparum resistance to artemisinin and its derivatives poses a threat to the global effort to control malaria. The emergence of anti-malarial resistance has become a great public health challenge and continues to be a leading threat to ongoing malaria control efforts. The aim of this review was to synthesize available evidence on the efficacy of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated falciparum malaria among children in Africa. A systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Central Register of Controlled Trials’ database (CENTRAL) for retrieving randomized control trials comparing efficacy of DHA-PQ and AL for treatment of uncomplicated falciparum malaria in African children. The search was performed from August 2020 to April 2021. Using Rev-Man software (V5.4.1), R-studio and Comprehensive Meta-analysis software version 3, the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI). In this review, 25 studies which involved a total of 13,198 participants were included. PCR-unadjusted treatment failure in children aged between 6 months and 15 years was significantly lower in the DHA-PQ treatment arm on day 28 than that of AL (RR 0.14, 95% CI 0.08–0.26; participants = 1302; studies = 4; I2 = 0%, high quality of evidence). Consistently, the PCR-adjusted treatment failure was significantly lower with DHA-PQ treatment group on day 28 (RR 0.45, 95% CI 0.29–0.68; participants = 8508; studies = 16; I2 = 51%, high quality of evidence) and on day 42 (RR 0.60, 95% CI 0.47–0.78; participants = 5959; studies = 17; I2 = 0%, high quality of evidence). However, the efficacy was ≥ 95% in both treatment groups on day 28. From this review, it can be concluded that DHA-PQ reduces new infection and recrudescence on days 28 and 42 more than AL. This may trigger DHA-PQ to become a first-line treatment option.

中文翻译：

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双氢青蒿素-哌喹与蒿甲醚-苯芴醇治疗非洲儿童无并发症恶性疟原虫疟疾的疗效：随机对照试验的系统评价和荟萃分析

恶性疟原虫对青蒿素及其衍生物的耐药性的出现对全球控制疟疾的努力构成了威胁。抗疟药耐药性的出现已成为一项重大的公共卫生挑战，并继续成为正在进行的疟疾控制工作的主要威胁。本综述的目的是综合现有证据，证明双氢青蒿素-哌喹 (DHA-PQ) 与蒿甲醚-芴芴醇 (AL) 相比，用于治疗非洲儿童的无并发症恶性疟。进行了系统的文献搜索，以从在线数据库 PubMed/MEDLINE、Embase、和 Cochrane 对照试验中央注册数据库 (CENTRAL)，用于检索比较 DHA-PQ 和 AL 治疗非洲儿童无并发症恶性疟的疗效的随机对照试验。检索时间为 2020 年 8 月至 2021 年 4 月。使用 Rev-Man 软件（V5.4.1）、R-studio 和综合 Meta 分析软件第 3 版，从符合条件的研究中提取的数据汇总为风险比（RR），为 95 % 置信区间 (CI)。本综述纳入了 25 项研究，共涉及 13,198 名参与者。在第 28 天，DHA-PQ 治疗组 6 个月至 15 岁儿童的 PCR 未调整治疗失败显着低于 AL（RR 0.14，95% CI 0.08-0.26；参与者 = 1302；研究 = 4； I2 = 0%，证据质量高）。一贯地，DHA-PQ 治疗组在第 28 天（RR 0.45，95% CI 0.29–0.68；参与者 = 8508；研究 = 16；I2 = 51%，高质量证据）和第42（RR 0.60，95% CI 0.47–0.78；参与者 = 5959；研究 = 17；I2 = 0%，证据质量高）。然而，在第 28 天，两个治疗组的疗效均≥ 95%。从该综述可以得出结论，DHA-PQ 在第 28 天和第 42 天比 AL 更能减少新感染和复发。这可能会触发 DHA-PQ 成为一线治疗选择。在第 28 天，两个治疗组的疗效均≥ 95%。从该综述可以得出结论，DHA-PQ 在第 28 天和第 42 天比 AL 减少新感染和复发。这可能会触发 DHA-PQ 成为一线治疗选择。在第 28 天，两个治疗组的疗效均≥ 95%。从该综述可以得出结论，DHA-PQ 在第 28 天和第 42 天比 AL 减少新感染和复发。这可能会触发 DHA-PQ 成为一线治疗选择。