Older Drugs May Be Good Stopgap Treatment For Malaria In Africa
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Article Date: 26 Jan 2006 - 2:00am (UK)
A combination of older malaria drugs could treat malaria effi-
ciently in some parts of Africa until a newer antimalarial drug
called is widely available in those areas, a new review of re-
cent studies suggests.
After 28 days of treatment, there were fewer cases of malaria
among children taking a combination of the older sulfadoxine-
pyrimethamine (sold under the brand name Fansidar) and amo-
diaquine than among patients taking a combination of Fansidar
and artesunate, a drug based on the newer antimalarial called
artemisinin.
However, the Fansidar-artesunate combination was more effective
than the other drug combination at clearing malaria parasites
from the blood at a particularly infectious stage of parasite
development, according to Dr. Hasifa Bukirwa of the Uganda Ma-
laria Surveillance Project and Julia Critchley of the Liverpool
School of Tropical Medicine in England.
Bukirwa and Critchley say Fansidar-amodiaquine may be a useful
stopgap treatment in areas without access to artemisinin drugs
and areas where malaria resistance to Fansidar and amodiaquine
is still low.
The review appears in the current issue of The Cochrane Library,
a publication of The Cochrane Collaboration, an international
organization that evaluates medical research. Systematic reviews
draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical
trials on a topic.
Artemisinin antimalarials are fast-acting and effective drugs
that have proved useful against multi-drug resistant strains of
the falciparum type of malaria. The World Health Organization
recommends combination therapy that includes artemisinin drugs
as the standard treatment in countries where malaria is resis-
tant to older individual drugs such as chloroquine and amo-
diaquine.
However, "artemisinin drugs are not yet widely available in Af-
rica and may not be for some time because of low production,
comparatively high cost, dosing complexity and the lack of
clinical experience with artemisinin-based combinations,"
Bukirwa and Critchley say.
The Cochrane reviewers analyzed four studies including 775 ma-
laria patients, children age six months to five years. The stud-
ies compared the Fansidar-amodiaquine treatment to Fansidar-
artesunate therapy for mild to moderate cases of falciparum ma-
laria.
In three of the studies, the Fansidar-amodiaquine treatment re-
duced by nearly 40 percent the risk of still having malaria af-
ter 28 days of treatment, compared to Fansidar-artesunate treat-
ment.
But the Fansidar-artesunate combination was more than twice as
likely as the other drug combination to reduce the number of in-
fectious malaria parasites in the blood to clinically insignifi-
cant levels. Reducing the parasite load is important because it
reduces the spread of the disease, the reviewers say.
Bukirwa and Critchley stress that the Fansidar-amodiaquine com-
bination should be considered useful and safe only in areas
where resistance to both drugs is low. They warn that resistance
may have increased since the studies in the review, conducted
between 2002 and 2005, were completed.
"It is possible that sulfadoxine-pyrimethamine may not be recom-
mended at all for first-line treatment of any malaria in Africa
in the future," Bukirwa said.
Although combination malaria therapies are also being tried in
Southeast Asia, where malaria is a major public health problem,
the Fansidar-amodiaquine combination is probably not a viable
treatment option for that region, says Dr. David Bell, a malaria
expert at the University of Liverpool in England.
The failure rates for both amodiaquine and Fansidar "on their
own tend to be considerable higher there than when they are used
in Africa as monotherapies," he explains. "As such, I don't
think the combination of amodiaquine and sulfadoxine-
pyrimethamine would even be considered in that setting."
Malaria affects 300 to 500 million people worldwide every year
and is the leading cause of illness and death in sub-Saharan Af-
rica, according to a 2000 WHO report.
The Bukirwa study was supported by the Department for Interna-
tional Development, UK and the Makerere University Malaria Pro-
ject, Uganda.
Bukirwa H, Critchley J.: Sulfadoxine-pyrimethamine plus artesu-
nate versus sulfadoxine-pyrimethamine plus amodiaquine for
treating uncomplicated malaria.
The Cochrane Database of Systematic Reviews 2006, Issue 1.
The Cochrane Collaboration is an international nonprofit, inde-
pendent organization that produces and disseminates systematic
reviews of health care interventions and promotes the search for
evidence in the form of clinical trials and other studies of in-
terventions.
Visit http://www.cochrane.org for more information.
Hasifa Bukirwa
Center for the Advancement of Health
mailto:hbukirwa@hotmail.com
http://www.cfah.org
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