BackgroundThe Bolivian northern Altiplano is characterized by a high prevalence of Fasciola hepatica infection. In order to assess the feasibility, safety and efficacy of large-scale administration of triclabendazole as an appropriate public health measure to control morbidity associated with fascioliasis, a pilot intervention was implemented in 2008.Materials and MethodsSchoolchildren from an endemic community were screened for fascioliasis and treated with a single administration of triclabendazole (10 mg/kg). Interviews to assess the occurrence of adverse events were conducted on treatment day, one week later, and one month after treatment. Further parasitological screenings were performed three months after treatment and again two months later (following a further treatment) in order to evaluate the efficacy of the intervention.ResultsNinety infected children were administered triclabendazole. Adverse events were infrequent and mild. No serious adverse events were reported. Observed cure rates were 77.8% after one treatment and 97.8% after two treatments, while egg reduction rates ranged between 74% and 90.3% after one treatment, and between 84.2% and 99.9% after two treatments. The proportion of high-intensity infections (≥400 epg) decreased from 7.8% to 1.1% after one treatment and to 0% after two treatments.ConclusionAdministration of triclabendazole is a feasible, safe and efficacious public health intervention in an endemic community in the Bolivian Altiplano, suggesting that preventive chemotherapy can be applied to control of fascioliasis. Further investigations are needed to define the most appropriate frequency of treatment.

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The adoption of artemisinin-based combination therapy, together with other malaria control strategies, has played a significant role in reducing the burden of malaria in many endemic countries. The artemisinin-based combination therapy artemether-lumefantrine (AL; Coartem(®), Novartis Pharma AG, Basel, Switzerland) has demonstrated consistently high efficacy and safety for over a decade. Currently deployed as a first- or second-line treatment in most sub-Saharan African countries, its extensive use is endorsed by a lack of reported parasite resistance in Africa to date. With a focus on patient needs, AL offers a tailored formulation for infants and children, and packaging solutions to promote adherence. Working towards malaria elimination, innovative strategies using AL, such as treatment of asymptomatic carriers, will be of interest. AL has the potential to continue playing an important role in saving lives.

Despite considerable advances in the treatment and prevention of malaria, Plasmodium falciparum is still a threat to millions of people across the world, particularly in sub-Saharan Africa, with infants and young children bearing the greatest burden in terms of morbidity and mortality. Since 1999, the artemisinin-based combination therapy artemether-lumefantrine (AL; Coartem) has been made available. A wealth of evidence supports consistently high efficacy of AL, and a favorable safety and tolerability profile has been demonstrated. The child-friendly dispersible formulation of AL has proven to be as effective and well tolerated as the standard tablets, and will encourage ease of administration and improved adherence to the drug regimen. This article reviews the significant impact made by AL on the progress in malaria control and describes the way forward for the Novartis Malaria Initiative in leading the fight against malaria.