Comparative Efficacy of ACT Regimens

Enrolled women were randomly allocated to one of the three ACTs using sealed envelopes: dihydroartemisinin-piperaquine (DP), artesunate-mefloquine (ASMQ), or extended regimen artemether-lumefantrine (AL+). DP was given at the standard dose (2.4 mg/kg dihydroartemisinin with 20 mg/kg piperaquine once daily for 3 days), rounded to the nearest half tablet (40 mg/320 mg dihydroartemisinin/piperaquine per tablet manufactured by Holley Pharmacy, China). ASMQ was given at the standard dose (once daily for 3 days) either as loose doses of artesunate (4 mg/kg/day) and mefloquine (8.3 mg/kg/day) or fixed dose (artesunate 200 mg with mefloquine hydrochloride 440 mg each day, manufactured by Far-Manguinhos, Brazil). The loose dose was rounded to the nearest quarter of a tablet for artesunate (50 mg/tablet, Guilin, China) and mefloquine (250 mg/tablet, Atlantic Laboratories Corp., Thailand). AL+ was given as an extended regimen: five tablets (20/120 mg artemether/lumefantrine per tablet, Novartis, Switzerland) twice per day for 4 days (at 0, 8, 24, 36, 48, 60, 72 and 84 h), with 250 mL of chocolate milk containing 7 g of fat for each dose. All doses were fully supervised.