Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone.

Hdl Handle:
http://hdl.handle.net/10144/17675
Title:
Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone.
Authors:
Grandesso, F; Hagerman, A; Kamara, S; Lam, E; Checchi, F; Balkan, S; Scollo, G; Durand, R; Guthmann, J P
Journal:
Tropical Medicine & International Health
Abstract:
OBJECTIVE: In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. METHODS: Method and outcome classification of the study complied with WHO guidelines. Children 6-59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. RESULTS: Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8-99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4-90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. CONCLUSION: The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone.
Affiliation:
Epicentre, Paris, France.
Publisher:
Wiley-Blackwell
Issue Date:
Jul-2006
URI:
http://hdl.handle.net/10144/17675
DOI:
10.1111/j.1365-3156.2006.01655.x
PubMed ID:
16827702
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.authorGrandesso, F-
dc.contributor.authorHagerman, A-
dc.contributor.authorKamara, S-
dc.contributor.authorLam, E-
dc.contributor.authorChecchi, F-
dc.contributor.authorBalkan, S-
dc.contributor.authorScollo, G-
dc.contributor.authorDurand, R-
dc.contributor.authorGuthmann, J P-
dc.date.accessioned2008-02-07T12:28:28Z-
dc.date.available2008-02-07T12:28:28Z-
dc.date.issued2006-07-
dc.identifier.citationLow efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone. 2006, 11 (7):1017-21 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid16827702-
dc.identifier.doi10.1111/j.1365-3156.2006.01655.x-
dc.identifier.urihttp://hdl.handle.net/10144/17675-
dc.description.abstractOBJECTIVE: In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. METHODS: Method and outcome classification of the study complied with WHO guidelines. Children 6-59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. RESULTS: Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8-99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4-90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. CONCLUSION: The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone.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.meshArtemisininsen
dc.subject.meshChild, Preschoolen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFemaleen
dc.subject.meshGenotypeen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshParasitemiaen
dc.subject.meshPolymerase Chain Reactionen
dc.subject.meshSesquiterpenesen
dc.subject.meshSierra Leoneen
dc.subject.meshTreatment Outcomeen
dc.titleLow efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone.en
dc.contributor.departmentEpicentre, Paris, France.en
dc.identifier.journalTropical Medicine & International Healthen

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