Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan

Malar J. 2005 Feb 24;4:14. doi: 10.1186/1475-2875-4-14.

Abstract

Background: The treatment for Plasmodium falciparum malaria in Sudan has been in process of change since 2003. Preceding the change, this study aimed to determine which artemisinin-based combination therapies is more effective to treat uncomplicated malaria in Malakal, Upper Nile, Sudan.

Methods: Clinical trial to assess the efficacy of 2 antimalarial therapies to treat P. falciparum infections in children aged 6-59 months, in a period of 42 days after treatment.

Results: A total of 269 children were followed up to 42 days. Artesunate plus Sulfadoxine/Pyrimethamine (AS+SP) and Artesunate plus Amodiaquine (AS+AQ) were both found to be efficacious in curing malaria infections by rapid elimination of parasites and clearance of fever, in preventing recrudescence and suppressing gametocytaemia. The combination of AS+SP appeared slightly more efficacious than AS+AQ, with 4.4% (4/116) versus 15% (17/113) of patients returning with malaria during the 6-week period after treatment (RR = 0.9, 95% CI 0.81-0.96). PCR analysis identified only one recrudescence which, together with one other early treatment failure, gave efficacy rates of 99.0% for AS+AQ (96/97) and 99.1% for AS+SP (112/113). However, PCR results were incomplete and assuming part of the indeterminate samples were recrudescent infections leads to an estimated efficacy ranging 97-98% for AS+SP and 88-95% for AS+AQ.

Conclusion: These results lead to the recommendation of ACT, and specifically AS+SP, for the treatment of uncomplicated falciparum malaria in this area of Sudan. When implemented, ACT efficacy should be monitored in sentinel sites representing different areas of the country.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amodiaquine / administration & dosage*
  • Amodiaquine / pharmacology
  • Antimalarials / administration & dosage
  • Antimalarials / pharmacology
  • Antimalarials / standards*
  • Artemisinins / administration & dosage*
  • Artemisinins / pharmacology
  • Artesunate
  • Child, Preschool
  • Drug Combinations
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infant
  • Malaria, Falciparum / drug therapy*
  • Male
  • Pyrimethamine / administration & dosage*
  • Pyrimethamine / pharmacology
  • Sesquiterpenes / administration & dosage*
  • Sesquiterpenes / pharmacology
  • Sudan
  • Sulfadoxine / administration & dosage*
  • Sulfadoxine / pharmacology

Substances

  • Antimalarials
  • Artemisinins
  • Drug Combinations
  • Sesquiterpenes
  • Amodiaquine
  • fanasil, pyrimethamine drug combination
  • Artesunate
  • Sulfadoxine
  • Pyrimethamine