1921
Volume 68, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

The safety and the efficacy of amodiaquine (AQ) alone, AQ plus sulfadoxine-pyrimethamine (SP) (AQ plus SP), and artesunate (ART) plus SP (ART plus SP), three possible alternatives to chloroquine (CQ), were investigated in 379 Rwandan children 6–59 months old with uncomplicated malaria who visited one urban/peri-urban health center and two rural health centers. The three treatment regimens were well tolerated and no serious adverse effects were observed. Children treated with AQ plus SP had less clinical failures than those treated with ART plus SP (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.06–0.81, = 0.01) or AQ alone (OR = 0.33, 95% CI = 0.07–1.10, = 0.08). Even after new infections were excluded, AQ plus SP was still significantly more efficacious than ART plus SP ( = 0.05). At day 14, the mean packed cell volume was significantly higher in the AQ plus SP group compared with the ART plus SP group ( = 0.02) and with the AQ alone group ( = 0.01). In Rwanda, AQ plus SP has been chosen to replace CQ as a first-line treatment. However, this is considered an interim measure and new combinations, possibly co-formulated, should be identified and tested.

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2003-06-01
2017-11-22
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References

  1. World Health Organization, 1993. Implementation of the Global Malaria Control Strategy. Report of a WHO Study Group on the implementation of the Global Plan of Action on Malaria Control 1993–2000. Geneva: World Health Organization.
  2. Shretta R, Omumbo J, Rapuoda B, Snow RW, 2000. Using evidence to change antimalarial drug policy in Kenya. Trop Med Int Health 5 : 755–764.
  3. Trape JF, 2001. The public health impact of chloroquine resistance in Africa. Am J Trop Med Hyg 64 (Suppl 1–2) : 12–17.
  4. Bloland PB, Lackritz EM, Kazembe PN, Were JB, Steketee R, Campbell CC, 1993. Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa. J Infect Dis 167 : 932–937.
  5. White NJ, Olliaro PL, 1996. Strategies for the prevention of antimalarial drug resistance: rationale for combination chemotherapy for malaria. Parasitol Today 12 : 399–401.
  6. White NJ, 1998. Preventing antimalarial drug resistance through combinations. Drug Res Updates 1 : 3–9.
  7. White NJ, 1999. Antimalaria drug resistance and combination chemotherapy. Philos Trans R Soc Lond B Biol Sci 354 : 739–749.
  8. Nosten F. van Vugt M, Price R, Luxemburger C, Thway KL, Brockman A, McGready R, ter Kuile F, Looareesuwan S, White NJ, 2000. Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study. Lancet 356 : 297–302.
  9. White NJ, Olliaro P, 1998. Artemisinin and derivatives in the treatment of uncomplicated malaria. Med Trop (Mars) 58 (Suppl 3) : 54–56.
  10. Hastings IM, D’Alessandro U, 2000. Modelling a predictable disaster: the rise and spread of drug resistant malaria. Parasitol Today 16 : 340–347.
  11. Ministère de la Santé, 1999. Rapport Annuel 1998 du Ministère de la Santé. Kigali, Rwanda.
  12. Warrell DA, Molyneux ME, Beales PF, 1990. Severe and complicated malaria. Trans R Soc Trop Med Hyg 84 (Supp. 2) : 1–65.
  13. Irion A, Felger I, Abdulla S, Smith T, Mull R, Tanner M, Hatz C, Beck HP, 1998. Distinction of recrudescences from new infection by PCR-RFLP analysis in a comparative trial of CGP 56 697 and chloroquine in Tanzanian children. Trop Med Int Health 3 : 490–497.
  14. World Health Organization, 1996. Assessment of Therapeutic Efficacy of Antimalarial Drugs For Uncomplicated Falciparum Malaria in Areas with Intense Transmission. Geneva: World Health Organization. WHO/MAL/96.1077.
  15. Doherty JF, Sadiq AD, Bayo L, Alloueche A, Olliaro P, Milligan P, von Seidlein L, Pinder M, 1999. A randomized safety and tolerability trial of artesunate plus sulfadoxine-pyrimethamine versus sulfadoxine-pyrimethamine alone for the treatment of uncomplicated malaria in Gambian children. Trans R Soc Trop Med Hyg 93 : 543–546.
  16. von Seidlein L, Milligan P, Pinder M, Bojang K, Anyalebechi C, Gosling R, Coleman R, Ude JI, Sadiq A, Duraisingh M, Warhurst D, Alloueche A, Targett G, McAdam K, Greenwood B, Walraven G, Olliaro P, Doherty T, 2000. Efficacy of artesunate plus pyrimethamine-sulphadoxine for uncomplicated malaria in Gambian children: a double-blind, randomised, controlled trial. Lancet 355 : 352–357.
  17. McIntosh HM, 2002. Chloroquine and amodiaquine combined with sulfadoxine-pyrimethamine for treating uncomplicated malaria (Cochrane Review). The Cochrane Library. Issue 3. Oxford: Update Software.
  18. Staedke SG, Kamya MR, Dorsey G, Gasasira A, Ndeezi G, Charlebois ED, Rosenthal PJ, 2001. Amodiaquine, sulfadoxine/ pyrimethamine, and combination therapy for the treatment of uncomplicated falciparum malaria in Kampala, Uganda: a randomised trial. Lancet 358 : 368–374.
  19. Wongsrichanalai C, Thimasarn K, Sirichaisinthop J, 2000. Antimalarial drug combination policy: a caveat. Lancet 355 : 2245–2247.
  20. Magesa SM, Mdira KY, Babiker HA, Alifrangis M, Farnert A, Simonsen PE, Bygbjerg IC, Walliker D, Jakobsen PH, 2002. Diversity of Plasmodium falciparum clones infecting children living in a holoendemic area in north-eastern Tanzania. Acta Trop 84 : 83–92.
  21. Greenwood B, 2002. The molecular epidemiology of malaria. Trop Med Int Health 7 : 1012–1021.
  22. Olliaro P, Mussano P, 2002. Amodiaquine for treating malaria (Cochrane Review). The Cochrane Library. Issue 3. Oxford: Update Software.
  23. Adjuik M, Agnamey P, Babiker A, Borrman S, Brasseur P, Cisse M, Cobelens F, Diallo S, Faucher JF, Garner P, Gikunda S, Kremsner PG, Krishna S, Lell B, Loolpapit M, Matsiegui P-B, Missinou MA, Mwanza J, Ntoumi F, Olliaro P, Osimbo P, Rezbach P, Some E, Taylor WRJ, 2002. Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children: a randomised, multicentre trial. Lancet 359 : 1365–1372.
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  • Received : 14 Oct 2002
  • Accepted : 10 Mar 2003

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