Document Detail


Comparison of artemether-lumefantrine with sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in eastern Nepal.
MedLine Citation:
PMID:  17827354     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Because available data suggest that resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) is increasing in Nepal, an open-label, parallel-group efficacy/safety study was conducted in 99 Nepalese patients with uncomplicated falciparum malaria randomized 2:1 to artemetherlumefantrine (AL) or SP. Efficacy was assessed from clinical and microscopic evidence of treatment failure. Four SP-treated patients (12.1%; 95% CI, 4.0-29.1%) redeveloped parasitemia during the 28-day follow-up versus 0% (95% CI, 0-6.9%) in the AL group (P = 0.011), a difference that was confirmed by polymerase chain reaction (PCR) analysis of parasite DNA. PCR detected an additional six patients (two SP and four AL) with sub-microscopic gametocytemia or breakthrough parasitemia between Days 14 and 28, suggesting that AL efficacy was lower than estimated by microscopy. Dhfr and dhps mutations were not associated with outcome. AL is more effective than SP for uncomplicated malaria in Nepal, but regular monitoring of its efficacy should be carried out if this combination therapy is introduced.
Authors:
Suman Thapa; Judith Hollander; Mary Linehan; Janet Cox-Singh; Mahendra B Bista; Garib D Thakur; Wendy A Davis; Timothy M E Davis
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The American journal of tropical medicine and hygiene     Volume:  77     ISSN:  0002-9637     ISO Abbreviation:  Am. J. Trop. Med. Hyg.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2007-11-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370507     Medline TA:  Am J Trop Med Hyg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  423-30     Citation Subset:  AIM; IM    
Affiliation:
Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Animals
Antimalarials / therapeutic use*
Artemisinins / therapeutic use*
Drug Combinations
Drug Resistance
Ethanolamines / therapeutic use*
Female
Fluorenes / therapeutic use*
Humans
Malaria, Falciparum / drug therapy*
Malaria, Vivax / diagnosis,  drug therapy
Male
Nepal
Plasmodium falciparum / drug effects,  genetics
Plasmodium vivax / isolation & purification
Pyrimethamine / therapeutic use*
Sulfadoxine / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antimalarials; 0/Artemisinins; 0/Drug Combinations; 0/Ethanolamines; 0/Fluorenes; 0/artemether-lumefantrine combination; 2447-57-6/Sulfadoxine; 37338-39-9/sulfadoxine-pyrimethamine; 58-14-0/Pyrimethamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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