Artesunate and sulfadoxine-pyrimethamine combinations for the treatment of uncomplicated Plasmodium falciparum malaria in Uganda: a randomized, double-blind, placebo-controlled trial

Transactions of the Royal Society of Tropical Medicine and Hygiene
Gerardo PriottoD Legros

Abstract

Drug-resistant malaria is spreading in Africa. The few available drugs might be safeguarded if combined with an artemisinin derivative. We investigated the efficacy, safety, and tolerability of 2 combinations of artesunate with sulfadoxine-pyrimethamine (SP) in a mesoendemic region in Uganda with SP resistance, from September 1999 to June 2000. In a randomized, double-blind, placebo-controlled trial, 420 children aged 6-59 months with uncomplicated Plasmodium falciparum malaria were assigned SP alone (25 mg/kg sulfadoxine, 1.25 mg/kg pyrimethamine) or combined with artesunate (AS; 4 mg/kg/d) for either 1 d (SPAS1) or 3 d (SPAS3). Children were followed-up for 28 d. Day 14 cure rates were 84.6% (99/117) with SPAS3 and 61.9% (73/118) with SPAS1 compared with 55.8% (86/154) with SP. Corresponding day 28 results were 74.4% (87/117) and 45.2% (52/115) compared with 40.5% (62/153). A significant improvement was obtained with the addition of 3 d, but not 1 d, of artesunate (risk ratio [RR] = 1.5, 95% CI 1.3-1.8 at 14 d and RR = 1.8, 95% CI 1.5-2.3 at 28 d). Both AS regimens achieved significantly faster parasite clearance and lower gametocyte carriage. All drug regimens were well tolerated, but SP alone was ineffective. Treatment effi...Continue Reading

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Citations

Feb 27, 2010·European Journal of Clinical Pharmacology·Sakina Babikir ElaminTarig Abedelgadir Mohamad
Jun 13, 2006·Transactions of the Royal Society of Tropical Medicine and Hygiene·Xavier de RadiguèsJean-Paul Guthmann
Aug 21, 2013·Parasitology·Alice S ButterworthKatharine R Trenholme
Jun 23, 2010·BMC Medical Research Methodology·Solange Youdom WhegangJean-Christophe Thalabard
Mar 13, 2014·The Journal of Infectious Diseases·Steve M Taylor, Jonathan J Juliano
Sep 20, 2007·Expert Opinion on Drug Safety·Rana ChattopadhyaySanjai Kumar
Jun 28, 2011·The Lancet Infectious Diseases·Frans Herwig Jansen
Feb 16, 2007·Tropical Medicine & International Health : TM & IH·Kefas MugittuWalter R J Taylor
Nov 30, 2019·Future Medicinal Chemistry·Ishan WadiAbhinav Sinha
Feb 6, 2019·Tropical Medicine and Infectious Disease·Christian Nsanzabana

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