Antimalarial efficacy of sulfadoxine-pyrimethamine, amodiaquine and a combination of chloroquine plus sulfadoxine-pyrimethamine in Bundi Bugyo, western Uganda.

Hdl Handle:
http://hdl.handle.net/10144/16894
Title:
Antimalarial efficacy of sulfadoxine-pyrimethamine, amodiaquine and a combination of chloroquine plus sulfadoxine-pyrimethamine in Bundi Bugyo, western Uganda.
Authors:
Checchi, F; Piola, P; Kosack, C; Ardizzoni, E; Klarkowski, D; Kwezi, E; Priotto, G; Balkan, S; Bakyaita, N; Brockman, A; Guthmann, J P
Journal:
Tropical Medicine & International Health
Abstract:
We report below an in vivo antimalarial efficacy study conducted in 2002 in Bundi Bugyo, a district of western Uganda housing a large displaced population. We tested sulfadoxine-pyrimethamine (SP), amodiaquine (AQ) and the combination chloroquine plus SP (CQ + SP). A total of 268 children with uncomplicated Plasmodium falciparum malaria were followed-up for 28 days according to WHO recommendations, with PCR genotyping to distinguish late recrudescences from re-infections. PCR-adjusted failure proportions at day 28 were 37.0% (34/92, 95% CI 27.1-47.7) in the SP group, 20.6% (14/68, 95% CI 11.7-32.1) in the AQ group and 22.8% (18/79, 95% CI 14.1-33.6) in the CQ + SP group. Early failures were particularly frequent in the SP group (15.2%). Clearance of gametocytes was slower in the SP and CQ + SP groups than in the AQ group. This study suggests that, in Bundi Bugyo, CQ + SP (Uganda's first-line regimen) will need to be replaced by a more efficacious regimen. Across Uganda, the deployment of SP containing combinations may not be a feasible long-term strategy. For Bundi Bugyo, we recommend a combination of artesunate and AQ. Our study also confirms previous findings that resistance is considerably underestimated by 14-day follow-ups. Antimalarial policy decisions should therefore be based on 28-day studies, with PCR adjustment to distinguish re-infections.
Affiliation:
Epicentre, Paris, France. fchecci@epicentre.msf.org
Publisher:
Wiley-Blackwell
Issue Date:
Apr-2004
URI:
http://hdl.handle.net/10144/16894
DOI:
10.1111/j.1365-3156.2004.01217.x
PubMed ID:
15078262
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorChecchi, F-
dc.contributor.authorPiola, P-
dc.contributor.authorKosack, C-
dc.contributor.authorArdizzoni, E-
dc.contributor.authorKlarkowski, D-
dc.contributor.authorKwezi, E-
dc.contributor.authorPriotto, G-
dc.contributor.authorBalkan, S-
dc.contributor.authorBakyaita, N-
dc.contributor.authorBrockman, A-
dc.contributor.authorGuthmann, J P-
dc.date.accessioned2008-01-25T14:53:57Z-
dc.date.available2008-01-25T14:53:57Z-
dc.date.issued2004-04-
dc.identifier.citationAntimalarial efficacy of sulfadoxine-pyrimethamine, amodiaquine and a combination of chloroquine plus sulfadoxine-pyrimethamine in Bundi Bugyo, western Uganda. 2004, 9 (4):445-50 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid15078262-
dc.identifier.doi10.1111/j.1365-3156.2004.01217.x-
dc.identifier.urihttp://hdl.handle.net/10144/16894-
dc.description.abstractWe report below an in vivo antimalarial efficacy study conducted in 2002 in Bundi Bugyo, a district of western Uganda housing a large displaced population. We tested sulfadoxine-pyrimethamine (SP), amodiaquine (AQ) and the combination chloroquine plus SP (CQ + SP). A total of 268 children with uncomplicated Plasmodium falciparum malaria were followed-up for 28 days according to WHO recommendations, with PCR genotyping to distinguish late recrudescences from re-infections. PCR-adjusted failure proportions at day 28 were 37.0% (34/92, 95% CI 27.1-47.7) in the SP group, 20.6% (14/68, 95% CI 11.7-32.1) in the AQ group and 22.8% (18/79, 95% CI 14.1-33.6) in the CQ + SP group. Early failures were particularly frequent in the SP group (15.2%). Clearance of gametocytes was slower in the SP and CQ + SP groups than in the AQ group. This study suggests that, in Bundi Bugyo, CQ + SP (Uganda's first-line regimen) will need to be replaced by a more efficacious regimen. Across Uganda, the deployment of SP containing combinations may not be a feasible long-term strategy. For Bundi Bugyo, we recommend a combination of artesunate and AQ. Our study also confirms previous findings that resistance is considerably underestimated by 14-day follow-ups. Antimalarial policy decisions should therefore be based on 28-day studies, with PCR adjustment to distinguish re-infections.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAmodiaquineen
dc.subject.meshAntimalarialsen
dc.subject.meshChild, Preschoolen
dc.subject.meshChloroquineen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDrug Combinationsen
dc.subject.meshDrug Resistanceen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshPyrimethamineen
dc.subject.meshSulfadoxineen
dc.subject.meshTreatment Failureen
dc.subject.meshTreatment Outcomeen
dc.subject.meshUgandaen
dc.titleAntimalarial efficacy of sulfadoxine-pyrimethamine, amodiaquine and a combination of chloroquine plus sulfadoxine-pyrimethamine in Bundi Bugyo, western Uganda.en
dc.contributor.departmentEpicentre, Paris, France. fchecci@epicentre.msf.orgen
dc.identifier.journalTropical Medicine & International Healthen

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