# \[e-drug\] Trial on treatment of uncomplicated falciparum malaria **URL:** \ **Category:** e-drug\ **Created:** [October 12, 2002, 11:49am UTC](https://talk.edrugplus.org/t/e-drug-trial-on-treatment-of-uncomplicated-falciparum-malaria/15126 "2002-10-12T11:49:26Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![e-drug2](https://avatars.discourse-cdn.com/v4/letter/e/8dc957/32.png) [@e-drug2](https://talk.edrugplus.org/u/e-drug2)\ **Post date:** [October 12, 2002, 11:49am UTC](https://talk.edrugplus.org/t/e-drug-trial-on-treatment-of-uncomplicated-falciparum-malaria/15126/1 "2002-10-12T11:49:26Z")
E-drug: Trial on treatment of uncomplicated falciparum malaria ------------------------------------------------------------------------- Lancet 2002; 360: 1136-43 (12 October) - Free [http://www.thelancet.com/journal/vol360/iss9340/full/llan.360.9340.original\_](http://www.thelancet.com/journal/vol360/iss9340/full/llan.360.9340.original_) research.22704.1 [Copied as fair use. KM] Chlorproguanil-dapsone versus sulfadoxine-pyrimethamine for sequential episodes of uncomplicated falciparum malaria in Kenya and Malawi: a randomised clinical trial J Sulo, P Chimpeni, J Hatcher, J G Kublin, C V Plowe, M E Molyneux, K Marsh, T E Taylor, W M Watkins, P A Winstanley ---------------------------------------------------------------------------- ---- Centre for Geographical Medicine, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya (J Sulo MBChB, Prof K Marsh); The Malawi-Liverpool-Wellcome Trust Programme for Tropical Medicine Research, Blantyre, Malawi (P Chimpeni MAC, Prof M Molyneux FRCP); Division of Epidemiology, Prevention and Screening, Alberta Cancer Board, Canada (J Hatcher PhD); Malaria Section, Center for Vaccine Development, University of Maryland School of Medicine, MD, USA (J G Kublin MD, Prof C V Plowe MD); Division of Tropical Medicine, Liverpool School of Tropical Medicine, UK (Prof M E Molyneux); Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (Prof K Marsh); Department of Medicine, College of Osteopathic Medicine, Michigan State University, MI, USA (Prof T E Taylor DO); Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3GE, UK (W M Watkins PhD, Prof P A Winstanley FRCP). ---------------------------------------------------------------------------- ---- Correspondence: Prof P A Winstanley (e-mail:peterwin@liv.ac.uk) Summary Background: Chlorproguanil-dapsone exerts lower resistance pressure on Plasmodium falciparum than does sulfadoxine-pyrimethamine, but is rapidly eliminated. We aimed to find out whether chlorproguanil-dapsone results in a higher retreatment rate for malaria than sulfadoxine-pyrimethamine. Methods: In a randomised trial of paediatric outpatients with uncomplicated falciparum malaria, patients received either chlorproguanil-dapsone or sulfadoxine-pyrimethamine and were followed up for up to 1 year. Sites were in Kenya (n=410) and Malawi (n=500). We used per-protocol analysis to assess the primary outcome of annual malaria incidence. Findings: Drop-outs were 117 of 410 (28�5%) in Kenya, and 342 of 500 (68�4%) in Malawi. Follow-up was for a median of 338 days (IQR 128-360) and 342 days (152-359) in Kilifi (chlorproguanil-dapsone and sulfadoxine-pyrimethamine, respectively), and for 120 days (33-281) and 84 days (26-224) in Blantyre. Mean annual malaria incidence was 2�5 versus 2�1 in Kenya (relative risk 1�16, 95% CI 0�98-1�37), and 2�2 versus 2�8 in Malawi (0�77, 0�63-0�94). 4�3% versus 12�8%, and 5�4% versus 20�1%, of patients were withdrawn for treatment failure in Kenya and Malawi, respectively. In Kenya haemoglobin concentration of 50 g/L or less caused exit in 6�9% of chlorproguanil-dapsone patients and 1�5% of sulfadoxine-pyrimethamine patients, but most anaemia occurred before re-treatment. In Malawi only one patient exited because of anaemia. Interpretation: Despite the rapid elimination of chlorproguanil-dapsone, children treated with this drug did not have a higher incidence of malaria episodes than those treated with sulfadoxine-pyrimethamine. Treatment failure was more common with sulfadoxine-pyrimethamine. Cause of anaemia in Kenya was probably not adverse reaction to chlorproguanil-dapsone, but this observation requires further study. -- To send a message to E-Drug, write to: e-drug@usa.healthnet.org To subscribe or unsubscribe, write to: majordomo@usa.healthnet.org in the body of the message type: subscribe e-drug OR unsubscribe e-drug To contact a person, send a message to: e-drug-help@usa.healthnet.org Information and archives: [http://www.healthnet.org/programs/edrug.html](http://www.healthnet.org/programs/edrug.html)