Efficacy of three artemisinin combination therapies for the treatment of uncomplicated Plasmodium falciparum malaria in the Republic of Congo.

Hdl Handle:
http://hdl.handle.net/10144/55473
Title:
Efficacy of three artemisinin combination therapies for the treatment of uncomplicated Plasmodium falciparum malaria in the Republic of Congo.
Authors:
van den Broek, I; Kitz, C; Al Attas, S; Libama, F; Balasegaram, M; Guthmann, J P
Journal:
Malaria Journal
Abstract:
BACKGROUND: Presented here are the results of a comparative trial on the efficacy of three artemisinin-based combinations conducted from May to October 2004, in Pool Province, Republic of Congo. METHODS: The main outcome was the proportion of cases of true treatment success at day 28. Recrudescences were distinguished from re-infections by PCR analysis. A total of 298 children of 6-59 months were randomized to receive either artesunate + SP (AS+SP), artesunate + amodiaquine (AS+AQ) or artemether + lumefantrine (AL), of which 15 (5%) were lost to follow-up. RESULTS: After 28 days, there were 21/85 (25%) recurrent parasitaemias in the AS+SP group, 31/97 (32%) in the AS+AQ group and 13/100 (13%) in the AL group. The 28-day PCR-corrected cure rate was 90.1% [95% CI 80.7-95.9] for AS+SP, 98.5% [95% CI 92.0-100] for AS+AQ and 100% [95.8-100] for AL, thereby revealing a weaker response to AS+SP than to AL (p = 0.003) and to AS+AQ (p = 0.06). A potential bias was the fact that children treated with AL were slightly older and in better clinical condition, but logistic regression did not identify these as relevant factors. There was no significant difference between groups in fever and parasite clearance time, improvement of anaemia and gametocyte carriage at day 28. No serious adverse events were reported. CONCLUSION: Considering the higher efficacy of AL as compared to AS+SP and the relatively high proportion of cases with re-infections in the AS+AQ group, we conclude that AL is clinically more effective than AS+SP and AS+AQ in this area of the Republic of Congo. Implementation of the recently chosen new national first-line AS+AQ should be monitored closely.
Affiliation:
Médecins sans Frontières, London, UK. ingrid.van.den.broek@rivm.nl <ingrid.van.den.broek@rivm.nl>
Publisher:
BioMed Central
Issue Date:
2006
URI:
http://hdl.handle.net/10144/55473
DOI:
10.1186/1475-2875-5-113
PubMed ID:
17125496
Additional Links:
http://www.malariajournal.com
Submitted date:
2009-03-13
Type:
Article
Language:
en
ISSN:
1475-2875
Sponsors:
Epicentre
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorvan den Broek, I-
dc.contributor.authorKitz, C-
dc.contributor.authorAl Attas, S-
dc.contributor.authorLibama, F-
dc.contributor.authorBalasegaram, M-
dc.contributor.authorGuthmann, J P-
dc.date.accessioned2009-03-16T01:16:15Z-
dc.date.available2009-03-16T01:16:15Z-
dc.date.issued2006-
dc.date.submitted2009-03-13-
dc.identifier.citationEfficacy of three artemisinin combination therapies for the treatment of uncomplicated Plasmodium falciparum malaria in the Republic of Congo. 2006, 5:113 Malar. J.en
dc.identifier.issn1475-2875-
dc.identifier.pmid17125496-
dc.identifier.doi10.1186/1475-2875-5-113-
dc.identifier.urihttp://hdl.handle.net/10144/55473-
dc.description.abstractBACKGROUND: Presented here are the results of a comparative trial on the efficacy of three artemisinin-based combinations conducted from May to October 2004, in Pool Province, Republic of Congo. METHODS: The main outcome was the proportion of cases of true treatment success at day 28. Recrudescences were distinguished from re-infections by PCR analysis. A total of 298 children of 6-59 months were randomized to receive either artesunate + SP (AS+SP), artesunate + amodiaquine (AS+AQ) or artemether + lumefantrine (AL), of which 15 (5%) were lost to follow-up. RESULTS: After 28 days, there were 21/85 (25%) recurrent parasitaemias in the AS+SP group, 31/97 (32%) in the AS+AQ group and 13/100 (13%) in the AL group. The 28-day PCR-corrected cure rate was 90.1% [95% CI 80.7-95.9] for AS+SP, 98.5% [95% CI 92.0-100] for AS+AQ and 100% [95.8-100] for AL, thereby revealing a weaker response to AS+SP than to AL (p = 0.003) and to AS+AQ (p = 0.06). A potential bias was the fact that children treated with AL were slightly older and in better clinical condition, but logistic regression did not identify these as relevant factors. There was no significant difference between groups in fever and parasite clearance time, improvement of anaemia and gametocyte carriage at day 28. No serious adverse events were reported. CONCLUSION: Considering the higher efficacy of AL as compared to AS+SP and the relatively high proportion of cases with re-infections in the AS+AQ group, we conclude that AL is clinically more effective than AS+SP and AS+AQ in this area of the Republic of Congo. Implementation of the recently chosen new national first-line AS+AQ should be monitored closely.en
dc.description.sponsorshipEpicentreen
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://www.malariajournal.comen
dc.rightsPublished by BioMed Central, [url]http://www.malariajournal.com/[/url] Archived on this site by Open Access permissionen
dc.subject.meshAmodiaquineen
dc.subject.meshAnimalsen
dc.subject.meshAntimalarialsen
dc.subject.meshArtemisininsen
dc.subject.meshChild, Preschoolen
dc.subject.meshDemocratic Republic of the Congoen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshEthanolaminesen
dc.subject.meshFemaleen
dc.subject.meshFluorenesen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshPlasmodium falciparumen
dc.subject.meshSesquiterpenesen
dc.subject.meshTreatment Outcomeen
dc.titleEfficacy of three artemisinin combination therapies for the treatment of uncomplicated Plasmodium falciparum malaria in the Republic of Congo.en
dc.typeArticleen
dc.contributor.departmentMédecins sans Frontières, London, UK. ingrid.van.den.broek@rivm.nl <ingrid.van.den.broek@rivm.nl>en
dc.identifier.journalMalaria Journalen

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