A randomized, placebo‐controlled, double‐blind trial on sulfadoxine–pyrimethamine alone or combined with artesunate or amodiaquine in uncomplicated malaria

Abstract

SummaryThe therapeutic efficacy of sulfadoxine-pyrimethamine (SP) alone, SP plus amodiaquine (AQ), and SP plus artesunate (AS) was assessed in a randomized, placebo-controlled, and double-blind trial among 438 children with uncomplicated Plasmodium falciparum malaria in northern Ghana. Clinical and parasitological responses were monitored for 28 days following treatment; 86%, 98% and 97% of SP-, SP + AQ-, and SP + AS-treated patients achieved adequate clinical and parasitological response (ACPR) within 2 weeks, respectively. Parasite clearance was better with SP + AS than with SP or SP + AQ treatment but re-infections were more common. Polymerase chain reaction (PCR)-corrected rates of ACPR at day 28 were 72.2% for SP, 94.1% for SP + AQ (P < 0.0001), and 94.5% for SP + AS (P < 0.0001). Gametocyte prevalence and density 1 week after treatment were highest in children treated with SP, and lowest in patients receiving SP + AS. No severe adverse events attributable to study medication were observed. In northern Ghana, more than one of four children suffered SP treatment failure within 4 weeks. Both SP + AQ and SP + AS are efficacious alternative therapeutic options in this region. Although SP + AS and SP + AQ treatments have virtually identical cure rates, rapid parasite clearance and pronounced gametocidal effects are the advantages of the former, whereas cost and a lower rate of late re-infections are those of the latter.

Chloroquine resistant Plasmodium falciparum malaria in Osogbo Nigeria: efficacy of amodiaquine + sulfadoxine-pyrimethamine and chloroquine + chlorpheniramine for treatment

“…It has been suggested that AQ+SP combination might be especially useful in West Africa, where resistance to both AQ and SP is low. This combination treatment had more than 94% efficacy against uncomplicated malaria in Nigeria (Sowunmi 2002) Ghana (Mockenhaupt et al 2005a), and Burkina Faso (Zongo et al 2005). The parasite clearance time in the combination of AQ+SP in our study was 2.2 ± 1.2 days this was similar to 2.1 ± 0.7 days that was reported in Ibadan in 2002 (Sowunmi 2002).…”

Gametocitemia en malaria por Plasmodium falciparum tratada con amodiaquina o artesunato

“…Los derivados de la artemisinina, como el artesunato, son esquizonticidas y tienen actividad sobre los gametocitos de P. falciparum (40)(41)(42)(43)(44)(45), reducen de forma importante la viabilidad de esos gametocitos jóvenes, tienen poco o nulo efecto sobre los gametocitos maduros y no se sabe cómo afectan la potencialidad infecciosa de los gametocitos para los anofelinos; en resumen, tienen un gran efecto sobre los gametocitos (36,46). La mefloquina tampoco elimina los gametocitos maduros de P. falciparum, sino que evita el desarrollo posterior de esas células por su actividad contra sus precursores (46).…”

Adherence and effectiveness of drug combination in curative treatment among children suffering uncomplicated malaria in rural Senegal

“…At D28, no therapeutic failure was noted among 181 patients who were administered both AQ and SP (Gaye, 2002). In Burkina Faso, Zongo et al (2005) found that this treatment was effective 95.8% of the time, and Mockenhaupt et al (2005) in Ghana observed an even higher rate of effectiveness (98%). Similar results were reported from Rwanda and Uganda, with 97.7% efficacy at D28 (Dorsey et al, 2003;Rwagacondo et al, 2003).…”