Ghana battles drug-resistant malaria with artesunate

Niagia, Santuah F

doi:10.1016/s0140-6736(04)16089-3

Cited by 8 publications

(9 citation statements)

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“…Nevertheless, in 2002 PYR-SDX was proposed to be an appropriate alternative to CQ for the first-line treatment of malaria in Ghanaian children (7). Meanwhile, and on the basis of several lines of evidence indicating the rapid emergence of PYR resistance, followed by SDX resistance several years later and the sustained maintenance of PYR resistance for many years (18), the official recommendation for first-line treatment of malaria has consequently been changed to artesunate-amodiaquine (26). The development of resistance and the failure of PYR treatment are a result of the initial and crucial pfdhfr S108N mutation, which leads to a moderate degree of resistance to PYR, which is enhanced by the subsequent pfdhfr N51I and pfdhfr C59R mutations (34).…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Markers for Sulfadoxine and Pyrimethamine Resistance in Plasmodium falciparum in the Absence of Drug Pressure in the Ashanti Region of Ghana

Marks

Evans

Meyer

et al. 2005

Antimicrob Agents Chemother

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Markers for Sulfadoxine and Pyrimethamine Resistance in Plasmodium falciparum in the Absence of Drug Pressure in the Ashanti Region of Ghana

Marks

Evans

Meyer

et al. 2005

Antimicrob Agents Chemother

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“…2000). The Ghana Health Service has decided to abandon CQ and to implement AQ–AS as first‐line antimalarial drug from 2005 on (Niagia 2004). Although the efficacy of this drug combination can be expected to be high (Adjuik et al.…”

Section: Discussionmentioning

confidence: 99%

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

Mockenhaupt

Ehrhardt

Dzisi

et al. 2005

Tropical Med Int Health

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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.

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“…The situation has worsened since Plasmodium falciparum chloroquine (CQ) resistance was first reported in Ghana in the late 1980s (Neequaye 1986). Current evidence (Ehrhardt et al 2002;Koram 2002) indicates that CQ is less useful than previously thought and thus supports the decision by the Ghana health service to change the current first-line treatment of uncomplicated malaria from CQ monotherapy to artesunate combination treatment (Niagia 2004). This decision is in line with the WHO's (2001) recommendation that artesunate combination treatment would increase cure rates, reduce transmission and prolong the lifespan of antimalarials.…”

Section: Introductionmentioning

confidence: 93%

A randomized comparative study of chloroquine, amodiaquine and sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Ghana

Oduro

Anyorigiya

Hodgson

et al. 2005

Trop Med Int Health

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SummaryThe study examined the efficacy of chloroquine (CQ), amodiaquine (AQ) and sulphadoxinepyrimethamine (SP) for the treatment of uncomplicated Plasmodium falciparum malaria in Ghana.A total of 351 children were randomized to receive either of the three study drugs. Patients were evaluated using the WHO 14-day in vivo antimalarial testing guidelines. The 14-day adequate clinical and parasitological response analysis revealed that CQ, 46.7% (95% CI 37.5, 56.0) has the least efficacy compared with AQ, 86.1% (95% CI 78.3, 91.8) and SP, 77.6% (95% CI 68.9, 84.8). Late parasite failures were also lower and similar in the AQ and SP (9.6% and 10.3%) than in the CQ (32.5%) group. However, CQ and AQ groups showed better fever clearance compared with SP throughout except for day 7 and after when possibly due to its significant late clinical failures, clearance by CQ was lower. Our findings suggest that CQ is no longer useful in Ghana and should be replaced as a first-line treatment of malaria. Replacement of CQ preferably with AQ combination treatment will be an effective and an affordable alternative for the treatment of uncomplicated malaria.

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Ghana battles drug-resistant malaria with artesunate

Cited by 8 publications

References 0 publications

High Prevalence of Markers for Sulfadoxine and Pyrimethamine Resistance in Plasmodium falciparum in the Absence of Drug Pressure in the Ashanti Region of Ghana

High Prevalence of Markers for Sulfadoxine and Pyrimethamine Resistance in Plasmodium falciparum in the Absence of Drug Pressure in the Ashanti Region of Ghana

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

A randomized comparative study of chloroquine, amodiaquine and sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Ghana

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