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DIHYDROARTEMISININ SUPPOSITORY IN MODERATELY SEVERE MALARIA: COMPARATIVE EFFICACY OF DIHYDROARTEMISININ SUPPOSITORY VERSUS INTRAMUSCULAR ARTEMETER FOLLOWED BY ORAL SULFADOXINE-PYRIMETHAMINE IN THE MANAGEMENT OF MODERATELY SEVERE MALARIA IN NIGERIAN CHILDREN

We compared two dose forms of artemisinin derivatives, dihydroartemisinin suppository (DHA) and intramuscular artemether (ART), in children 6 months to 10 years of age with moderately severe malaria for which oral therapy was not appropriate. Children were randomly allocated to receive three daily doses of DHA or ART followed by a single oral dose of sulfadoxine-pyrimethamine on the third day of both treatment regimens and were monitored for parasitologic and clinical response for 14 days. At enrollment, parasite density was 1,640–523,333/µL (geometric mean parasite density [GMPD] = 58,129/µL) in patients treated with DHA, whereas that for children who received ART was 1,440–559,400/µL (GMPD = 60,387/µL). Mean parasite and fever clearance times were similar in both groups. Days 14 and 28 parasitologic cure rates were 100% (34 of 34) and 96.2% (25 of 26) versus 96.2% (25 of 26) and 91.7% (22 of 24) for children treated with DHA and ART, respectively. In conclusion, both treatment regimens were efficacious and well tolerated.

Received November 30, 2005. Accepted for publication July 25, 2006.

Acknowledgments: The American Society of Tropical Medicine and Hygiene (ASTMH) and the American Committee on Clinical Tropical Medicine and Travelers’ Health (ACCTMTH) assisted with publication expenses.

^* Address correspondence to Catherine O. Falade, Malaria Research Laboratories, IMRAT, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: fallady{at}scannet.com or lillyfunke{at}yahoo.com

Authors’ addresses: Catherine O. Falade, Christian T. Happi, Grace O. Gbotosho, and Ayoade M. J. Oduola, Malaria Research Laboratories, IMRAT, College of Medicine, University of Ibadan, Ibadan, Nigeria, Telephone: 234-803-326-4593, E-mail: fallady{at}skannet.com or lillyfunke{at}yahoo.com. Christian T. Happi, E-mail: christianhappi{at}hotmail.com. Grace O. Gbotosho, E-mail: sgbot{at}skannet.com. Ayoade M. J. Oduola, E-mail: oduolaa{at}who.int. Lateef A. Salako, Malaria Research Laboratories, IMRAT, College of Medicine, University of Ibadan, Ibadan, Nigeria, and Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria, Telephone: 234-2-2410954. Francis F. Fadero, St. Mary’s Catholic Hospital, Eleta, Ibadan, Nigeria, and Department of Pediatrics, Ladoke Akintola University, Oshogbo, Nigeria, E-mail: folifad{at}gmail.com, Telephone: 234-8033536410. Idowu Ayede and Adegoke G. Falade, Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria, Telephone: 234-803-353-6410, E-mail: afalade33{at}yahoo.com. Hannah O. Dada-Adegbola, Department of Medical Microbiology, College of Medicine, University of Ibadan, Ibadan, Nigeria, Telephone: 234-802-345-1676, E-mail: dadaadegbola{at}yahoo.com.