Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan


van Den Broek, I; Amsalu, R; Balasegaram, M; Hepple, P; Alemu, E; Hussein el, B; Al-Faith, M; Montgomery, J; Checchi, F; (2005) Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan. Malar J, 4 (1). p. 14. ISSN 1475-2875 DOI: 10.1186/1475-2875-4-14

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Abstract

BACKGROUND: The treatment for Plasmodium falciparum malaria in Sudan has been in process of change since 2003. Preceding the change, this study aimed to determine which artemisinin-based combination therapies is more effective to treat uncomplicated malaria in Malakal, Upper Nile, Sudan. METHODS: Clinical trial to assess the efficacy of 2 antimalarial therapies to treat P. falciparum infections in children aged 6-59 months, in a period of 42 days after treatment. RESULTS: A total of 269 children were followed up to 42 days. Artesunate plus Sulfadoxine/Pyrimethamine (AS+SP) and Artesunate plus Amodiaquine (AS+AQ) were both found to be efficacious in curing malaria infections by rapid elimination of parasites and clearance of fever, in preventing recrudescence and suppressing gametocytaemia. The combination of AS+SP appeared slightly more efficacious than AS+AQ, with 4.4% (4/116) versus 15% (17/113) of patients returning with malaria during the 6-week period after treatment (RR = 0.9, 95% CI 0.81-0.96). PCR analysis identified only one recrudescence which, together with one other early treatment failure, gave efficacy rates of 99.0% for AS+AQ (96/97) and 99.1% for AS+SP (112/113). However, PCR results were incomplete and assuming part of the indeterminate samples were recrudescent infections leads to an estimated efficacy ranging 97-98% for AS+SP and 88-95% for AS+AQ. CONCLUSION: These results lead to the recommendation of ACT, and specifically AS+SP, for the treatment of uncomplicated falciparum malaria in this area of Sudan. When implemented, ACT efficacy should be monitored in sentinel sites representing different areas of the country.

Item Type: Article
Keywords: Amodiaquine/*administration & dosage/pharmacology, Antimalarials/administration & dosage/pharmacology/*standards, Artemisinins/*administration & dosage/pharmacology, Child, Preschool, Drug Combinations, Drug Therapy, Combination, Female, Humans, Infant, Malaria, Falciparum/*drug therapy, Male, Pyrimethamine/*administration & dosage/pharmacology, Sesquiterpenes/*administration & dosage/pharmacology, Sudan, Sulfadoxine/*administration & dosage/pharmacology, Amodiaquine, administration & dosage, pharmacology, Antimalarials, administration & dosage, pharmacology, standards, Artemisinins, administration & dosage, pharmacology, Child, Preschool, Drug Combinations, Drug Therapy, Combination, Female, Humans, Infant, Malaria, Falciparum, drug therapy, Male, Pyrimethamine, administration & dosage, pharmacology, Sesquiterpenes, administration & dosage, pharmacology, Sudan, Sulfadoxine, administration & dosage, pharmacology
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Pathogen Molecular Biology
Research Centre: ECOHOST - The Centre for Health and Social Change
PubMed ID: 15730557
Web of Science ID: 227951200001
URI: http://researchonline.lshtm.ac.uk/id/eprint/9109

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