E-drug: Treatment of falciparum malaria in Kampala, Uganda
-------------------------------------------------------------------------
[Copied as fair use. KM]
Lancet 2001; 358: 368-74
Amodiaquine, sulfadoxine/pyrimethamine, and combination therapy
for treatment of uncomplicated falciparum malaria in Kampala,
Uganda: a randomised trial.
Sarah G Staedke, Moses R Kamya, Grant Dorsey, Anne Gasasira,
Grace Ndeezi, Edwin D Charlebois, Philip J Rosenthal
Summary
Background: Increasing Plasmodium falciparum resistance to
chloroquine in sub-Saharan Africa necessitates use of alternative
antimalarial agents. Affordable alternative treatments include
sulfadoxine/pyrimethamine and amodiaquine. Combination of
antimalarial agents can increase therapeutic efficacy and delay
emergence of drug resistance. We compared the efficacy of
sulfadoxine/ pyrimethamine, amodiaquine, and an amodiaquine/
sulfadoxine/pyrimethamine combination for treatment of
uncomplicated malaria in a region of high chloroquine resistance.
Methods: Patients with symptoms of uncomplicated falciparum
malaria and confirmed disease in Kampala, Uganda, were randomly
assigned to receive sulfadoxine/pyrimethamine (25 mg/kg
sulfadoxine, and 1�25 mg/kg pyrimethamine) plus placebo;
amodiaquine (25 mg/kg) plus placebo; or amodiaquine plus
sulfadoxine/pyrimethamine. Patients were followed up for 14 days,
and clinical and parasitological outcomes were assessed.
Findings: 90% (400/445) of patients enrolled in the study
successfully completed 14 days of follow-up. Treatment failure
based on clinical criteria occurred in 13 of 131 (10%) patients on
sulfadoxine/ pyrimethamine, nine of 131 (7%) on amodiaquine, and
four of 138 (3%) on amodiaquine/sulfadoxine/pyrimethamine. Based
on parasitological criteria, treatment failed in 26%, 16%, and 10%
of these patients, respectively.
Amodiaquine/sulfadoxine/pyrimethamine was significantly more
effective than sulfadoxine/pyrimethamine alone in children aged
younger than 5 years (clinical failure in 3�5% vs 13�9%,
respectively, risk difference 10�4% [95% CI, 1�6-19�3]
p=0�021; parasitological failure in 12�8% vs 26�4%, risk
difference 13�6% [1�2-26�0] p=0�041).
Interpretation: Sulfadoxine/pyrimethamine, amodiaquine, and
amodiaquine/sulfadoxine/pyrimethamine were all effective for
treatment of uncomplicated falciparum malaria in Uganda. The
amodiaquine/sulfadoxine/ pyrimethamine combination was the most
effective, and could be the optimum low-cost alternative to
chloroquine in Africa.
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Information and archive http://satellife.healthnet.org/programs/edrug.html
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.