***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background Artemisinin-based combination therapy is increasingly being adopted as first-line antimalarial therapy . The choice of appropriate therapy depends on efficacy , cost , side effects , and simplicity of administration . Methods the efficacy of fixed co-formulated ( f ) artesunate-sulfamethoxypyrazine-pyrimethamine ( AS+SMP f ) administered at time intervals of 12 hours for a 24-hour therapy was compared with the efficacy of the same drug given as a loose combination ( AS+SMP l ) with a dose interval of 24 hours for 3 days for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan . Results seventy-three patients ( 39 and 34 in the fixed and the loose regimen of AS+SMP respectively ) completed the 28-days of follow-up . On day 3 ; all patients in both groups were a parasitaemic but one patient in the fixed group of AS+SMP f was still febrile . Polymerase chain reaction genotyping adjusted cure rates on day 28 were 92.3 % and 97.1 % ( P > 0.05 ) for the fixed and loose combination of AS+SMP respectively . Three ( 4.1 % ) patients ( one in the fixed and two patients in the loose group of AS+SMP ) in the study suffered drug-related adverse effects . Gametocytaemia was not detected during follow-up in any of the patients . Conclusion both regimens of AS+SMP were effective and safe for the treatment of uncomplicated P. falciparum malaria in eastern Sudan . Due to its simplicity , the fixed dose one-day treatment regimen may improve compliance and therefore may be the preferred choice Background Artemisinin-based combination therapy ( ACT ) , together with other control measures , have reduced the burden of falciparum malaria in sub-Saharan countries , including Sudan . Sudan adopted ACT in 2004 with a remarkable reduction in mortality due to falciparum malaria . However , emergence of resistance to the first-line treatment artesunate and sulfadoxine/pyrimethamine ( AS/SP ) has created new challenges to the control of malaria in Sudan . A search for an alternative drug of choice for treating uncomplicated malaria has become inevitable . The objective of this study was to evaluate the therapeutic efficacies of dihydroartemisinin/piperaquine ( DHA – PPQ ) and AS/SP in an area of unstable transmission in Blue Nile State , Sudan in 2015–16 . Methods A total of 148 patients with uncomplicated malaria were recruited in the study from November 2015 to end of January 2016 . Seventy-five patients received DHA – PPQ  while 73 received  AS/SP . Patients were monitored for clinical and parasitological outcomes following the st and ard WHO protocol for a period of 42 days for DHA – PPQ and 28 days for AS/SP ; nested PCR ( nPCR ) was performed to confirm parasite re-appearance from day 7 onwards . Results Fifty-five patients completed the DHA – PPQ arm protocol with success cure rate of 98.2 % ( 95 % CI 90.3–100 % ) and one late clinical failure 1.8 % ( 95 % CI 0.0–9.7 % ) . The AS/SP showed adequate clinical and parasitological response ( ACPR ) of 83.6 % ( 95 % CI 71.9–91.8 % ) , early treatment failure was 1.6 % ( 95 % CI 0.0–8.8 % ) and late parasitological failure ( LPF ) was 14.8 % ( 95 % CI 7–26.2 % ) . The respective PCR uncorrected LPF was 20 % . Conclusion DHA – PPQ is an efficacious ACT and c and i date for replacement of first-line treatment in Sudan while AS/SP showed high treatment failure rate and must be replaced OBJECTIVE To determine the therapeutic efficacy of artesunate + sulphadoxine/pyrimethamine ( AS + SP ) and artemether + lumefantrine ( AL ) , and to investigate the presence of molecular mutations associated with resistance , to inform national malaria treatment policy . METHODS One-arm prospect i ve studies were conducted in three study sites in Somalia in 2013 and 2015 to evaluate the efficacy of AS + SP and AL  among patients with uncomplicated falciparum malaria . Outcomes included clinical and parasitological response over 28 days , and the presence of dihydrofolate reductase ( dfhr ) and dihydropteroate synthase ( dhps ) and mutations . RESULTS Among patients treated with AS + SP , the PCR-corrected treatment failure rate was 12.3 % . The majority of patients ( 89 % ) carried either the quintuple mutations ( 51I/108N + 437G/540E/581 G or 51I/59R/108N + 437G/540E ) or the quadruple mutation ( 51I/108N + 437G/540E ) . All patients who failed treatment with AS + SP carried the quintuple mutation ( 51I/108N + 437G/540E/581 G ) . In the studies of AL , the PCR-corrected treatment failure rate was < 6 % . All patients in both treatment groups cleared their parasitaemia by day 3 . CONCLUSIONS The findings demonstrate a failing first-line treatment ( AS + SP ) , with a failure rate above the threshold ( 10 % ) for policy change , and a high prevalence of quintuple mutations . In contrast , AL was highly efficacious . Based on these findings and the results from a previous AS + SP study , AL was selected to replace AS + SP as the first-line treatment for uncomplicated malaria in Somalia in 2016 . Dihydroartemisinin + piperaquine ( DHA + PPQ ) has been recommended as the second-line treatment . Routine monitoring of recommended ACTs should continue to inform treatment policy Both northern and southern Sudan are deploying artemisinin-based combinations against uncomplicated Plasmodium falciparum malaria ( artesunate+sulfadoxine-pyrimethamine [ AS+SP ] in the north , artesunate+amodiaquine [ AS+AQ ] in the south ) . In 2003 , we tested the efficacy of 3 day AS+SP and AS+AQ regimens in vivo in the isolated , seasonally endemic Nuba Mountains region ( the first study of AS combinations in southern Sudan ) . We also analysed pre-treatment blood sample s for mutations at the P. falciparum chloroquine transporter ( Pfcrt ) gene ( associated with CQ resistance ) , and at the dihydrofolate reductase ( Dhfr ) gene ( associated with pyrimethamine resistance ) . Among 161 r and omized children under 5 years , PCR-corrected cure rates after 28 days were 91.2 % ( 52/57 , 95 % CI 80.7 - 97.1 ) for AS+SP and 92.7 % ( 51/55 , 95 % CI 82.4 - 98.0 ) for AS+AQ , with equally rapid parasite and fever clearance . The Pfcrt K76 T mutation occurred in 90.0 % ( 144/160 ) of infections , suggesting CQ would work poorly in this region . Overall , 82.5 % ( 132/160 ) carried mutations at Dhfr ( N51I , C59R or S108N , but not I164L ) , but triple mutants ( more predictive of in vivo SP failure ) were rare ( 3.1 % ) . CQ use should be rapidly discontinued in this region . SP resistance may propagate rapidly , and AS+AQ is likely to be a better long-term option , provided AQ use is limited to the combination Sixty-six children presenting to Singa hospital , Sudan with different manifestations of severe Plasmodium falciparum malaria were r and omly divided into two well-matched groups ( 33 in each arm ) to receive either intravenous artesunate 2·4 mg/kg at 0 , 12 , and 24 hours , then daily , or intravenous quinine 20mg/kg initially then 10mg/kg three times a day . There was no significant difference in the fever , parasite clearance , and coma resolution times . Three patients died , one in the artesunate and two in the quinine groups . One patient developed hypoglycaemia following quinine infusion . Thus , artesunate can be used for the treatment of severe falciparum malaria INTRODUCTION There is a need to investigate the treatment ( artesunate and quinine ) of severe malaria , as this will influence the outcome of morbidity and the mortality of the disease . METHODOLOGY An open r and omized trial conducted at Kassala , Sudan . Patients with severe P. falciparum malaria were r and omly assigned to either intravenous artesunate at 2.4 mg/kg at 0 , 12 , and 24 hours , then daily , or intravenous quinine at a 20 mg/kg loading dose , then 10 mg/kg three times a day . Fever and parasite clearance and coma resolution time were compared between the two groups . RESULTS The two groups ( 47 in each group ) were well matched in the clinical and biochemical characteristics . Hypotension , convulsions , severe anemia , hypoglycemia , cerebral malaria , and jaundice were the predominant manifestations of severe malaria . The mean ( SD ) of the fever clearance ( 10.8 [ 5.5 ] vs. 14.0 [ 8.1 ] hours , p = 0.028 ) and the parasite clearance time ( 16.5 [ 6.4 ] vs. 21.7 [ 11.3 ] hours , p = 0.007 ) were significantly shorter in the artesunate-treated patients . In comatose patients , there was no difference between the two groups in coma resolution time . Following quinine infusion , ten patients developed tinnitus ( p < 0.001 ) , and four had hypoglycemia ( p = 0.033 ) . Tinnitus and hypoglycemia were not detected in the artesunate group . One patient in the artesunate group died . CONCLUSIONS Artesunate is more effective than quinine , in term of parasite and fever clearance time , in the treatment of P. falciparum malaria in eastern Sudan . The study found no difference between artesunate and quinine in coma resolution time Abstract Background Artesunate + sulfadoxine-pyrimethamine ( AS + SP ) has been the first-line treatment and artemether-lumefantrine ( AL ) the second-line treatment for uncomplicated falciparum malaria in Yemen since 2005 . This paper reports the results of studies conducted to monitor therapeutic efficacy of these two drugs in sentinel sites in Yemen . Methods Eight therapeutic efficacy studies were conducted in six sentinel sites during the period 2009–2013 in Yemen . Five studies were for the evaluation of  AS + SP ( total of 465 patients ) and three studies ( total of 268 patients ) for the evaluation of AL . The studies were done according to st and ard WHO protocol 2009 with 28-day follow-up . Results In the evaluation of AS + SP , the PCR-corrected cure rate was 98 % ( 95 % CI 92.2–99.5 % ) in one site and 100 % in all of the other four sites . In the sites where AL was evaluated , the PCR-corrected cure rate was 100 % in all the sites . All patients were negative for asexual parasitaemia on day 3 in both the AS + SP and the AL groups . There was a higher rate of clearance of gametocytaemia in the AL-treated group when compared with the AS + SP groups from day 7 onwards . Conclusion AS + SP remains the effective drug for uncomplicated falciparum malaria in Yemen . AL is also highly effective and can be an appropriate alternative to AS + SP for the treatment of falciparum malaria . AL demonstrated a higher efficacy in clearing microscopic gametocytaemia than AS + SP.Trial registration : Trial registration number Purpose The aim of this study was to investigate the efficacy of artemether-lumefantrine in treating uncomplicated Plasmodium falciparum malaria in four sentinel areas in Sudan with different malaria transmission ( Damazin , Sinnar , and Kosti in the north , and Juba in the south ) . Methods World Health Organization protocol for assessing antimalarial drug efficacy in treating uncomplicated P. falciparum malaria was employed . A total of 2,139 patients were screened , and 771 had P. falciparum monoinfection . Only 291 met the enrollment criteria and gave written consent to be recruited in the study . Patients were treated with artemether-lumefantrine tablets in a six-dose regimen calculated according to body weight . Tablets were given at 0 , 8 , 24 , 36 , 48 , and 60 h. Patients were followed up for 28 days . Results A total of 291 patients were recruited to the study , of whom ten [ 3.4 ; 95 % confidence interval (CI):1.8–6.4 % ] patients showed early treatment failure ( ETF ) or late clinical failure ( LCF ) and were excluded from further follow-up . Of the remaining 281 patients , 276 ( 98.2 % ; 
    Output:
    
AL regimen showed higher efficacy  compared to AS + SP .
The overall regimens were associated with mild low rates ADRs