Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan


Durrani, N; Leslie, T; Rahim, S; Graham, K; Ahmad, F; Rowland, M; (2005) Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan. Tropical medicine & international health, 10 (6). pp. 521-529. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2005.01429.x

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Abstract

INTRODUCTION In South and Central Asia resistance to chloroquine (CQ) has reached unmanageable levels, and resistance to sulfadoxine-pyrimethamine (SP) is emerging. Amodiaquine (AQ) is widely used in the region, and elsewhere shows only partial resistance to CQ. In Afghanistan, one option for slowing the spread of resistance and improving treatment outcomes is the use of artemisinin combination therapy (ACT). METHODS The efficacy of CQ, AQ, SP and amodiaquine plus artesunate (AQ/AS) in the treatment of uncomplicated falciparum malaria was investigated using standard World Health Organization (WHO) procedures. Malaria patients were randomized to four treatment groups: 268 were enrolled and 240 completed the trial. RESULTS There was a high level of cross-resistance between CQ and AQ resistance: adequate clinical and parasitological response by day 42 was 11% after CQ treatment and 9% after AQ treatment. The trend of treatment failure between AQ and CQ was almost identical. Cure rates were considerably improved by the addition of artesunate to AQ or by use of SP; adequate clinical and parasitological response being 72% for AQ/AS and 92% for SP. The combination of AS/AQ substantially reduced the odds of treatment failure relative to AQ monotherapy by day 42 [odds ratio (OR) = 0.03, 95% confidence interval (CI) 0.01-0.1] in addition to reducing the proportion of patients with gametocytes throughout the 42-day period. Gametocyte carriage rate was only marginally higher in the SP than in the CQ- and AQ-treated groups. CONCLUSION The therapeutic and parasitological cure rates with AS/AQ were inadequate, and the criteria for deploying ACT - namely to prevent further selection of drug resistance from a position of low frequency - was not met in the region. An alternative drug combination to AQ/AS is required for Afghanistan.

Item Type: Article
Keywords: ACT, combination therapy, amodiaquine, malaria, Afghanistan, MALARIA, RESISTANCE, PAKISTAN, Adolescent, Adult, Afghanistan, epidemiology, Aged, Amodiaquine, therapeutic use, Antimalarials, therapeutic use, Artemisinins, therapeutic use, Child, Child, Preschool, Chloroquine, therapeutic use, Drug Combinations, Drug Resistance, Drug Synergism, Drug Therapy, Combination, Female, Humans, Malaria, Falciparum, drug therapy, epidemiology, Male, Middle Aged, Parasite Egg Count, Pyrimethamine, therapeutic use, Sesquiterpenes, therapeutic use, Sulfadoxine, therapeutic use, Treatment Failure, Treatment Outcome
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Malaria Centre
PubMed ID: 15941414
Web of Science ID: 229492500004
URI: http://researchonline.lshtm.ac.uk/id/eprint/6384

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