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    Mar 03, 2021
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    Artesunate and sulfadoxine-pyrimethamine combinations for the treatment of uncomplicated Plasmodium falciparum malaria in Uganda: a randomized, double-blind, placebo-controlled trial.

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    Authors
    Priotto, G
    Kabakyenga, J K
    Pinoges, L
    Ruiz, A
    Eriksson, T
    Coussement, F
    Ngambe, T
    Taylor, W R J
    Perea, W
    Guthmann, J P
    Olliaro, P
    Legros, D
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    Affiliation
    Epicentre, 8 rue Saint Sabin, 75011 Paris, France. gpriotto@epicentre.msf.org
    Issue Date
    2008-01-25T15:48:35Z
    
    Metadata
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    Journal
    Transactions of the Royal Society of Tropical Medicine and Hygiene
    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 efficacy improved with SPAS3 but the cure rate at day 28 was modest. The combinations were well tolerated and safe. In areas where SP resistance is prevalent other combinations should be considered.
    Publisher
    Elsevier
    URI
    http://hdl.handle.net/10144/16896
    PubMed ID
    15228253
    Additional Links
    http://www.sciencedirect.com/science/journal/00359203
    Language
    en
    ISSN
    0035-9203
    Collections
    Malaria

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