THE ADDITION OF ARTESUNATE TO CHLOROQUINE FOR TREATMENT OF PLASMODIUM FALCIPARUM MALARIA IN GAMBIAN CHILDREN DELAYS, BUT DOES NOT PREVENT TREATMENT FAILURE

COLIN J. SUTHERLAND Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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CHRISTOPHER J. DRAKELEY Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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UCHE OBISIKE Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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ROSALIND COLEMAN Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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MUSA JAWARA Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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GEOFFREY A. T. TARGETT Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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PAUL MILLIGAN Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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MARGARET PINDER Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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GIJS WALRAVEN Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Joint Malaria Programme, Moshi, Tanzania; Farafenni Field Station and Fajara Medical Research Council Laboratories, Banjul, The Gambia

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In a randomized controlled trial, chloroquine monotherapy was compared with the combination of artesunate and chloroquine for treating uncomplicated Plasmodium falciparum malaria in 536 Gambian children. Chloroquine-treated children exhibited a 28-day clinical failure rate of 15% (95% confidence interval [CI] = 9.2–22%) compared with 11% (7.8–15%) among children receiving the combination (P = 0.08, by Wilcoxon test). Seventy-three percent of chloroquine-treated children exhibited parasitemia during follow-up compared with 49% of children receiving the combination (relative risk = 1.5, 95% CI = 1.3–1.7; χ2 = 21.18, P < 0.001). A significant reduction in clinical and parasitologic treatment failure in the combination group occurred in the first two weeks following treatment, but this was eroded over weeks three and four of follow-up. The impact of combination therapy on the transmission of chloroquine-resistant parasites is discussed. Chloroquine plus artesunate is not sufficiently efficacious to justify its introduction as a replacement for chloroquine monotherapy in The Gambia.

Author Notes

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