Document Detail


Low efficacy of amodiaquine or chloroquine plus sulfadoxine-pyrimethamine against Plasmodium falciparum and P. vivax malaria in Papua New Guinea.
MedLine Citation:
PMID:  17984359     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Because of increasing resistance to 4-aminoquinolines in Papua New Guinea, combination therapy of amodiaquine (AQ) or chloroquine (CQ) plus sulfadoxine-pyrimethamine (SP) was introduced as first-line treatment against uncomplicated malaria in 2000. The purpose of this study was to monitor in vivo efficacy of the current standard combination therapy against Plasmodium falciparum and P. vivax malaria. Studies were conducted between 2003 and 2005 in the Simbu, East Sepik, and Madang Provinces in Papua New Guinea according to the revised protocol of the World Health Organization (WHO) for assessment of antimalarial drug efficacy. Children between six months and seven years of age with clinically overt and parasitologically confirmed P. falciparum or P. vivax malaria were treated according to the new policy guidelines (i.e., AQ plus SP given to patients weighing < 14 kg and CQ plus SP given to patients weighing < 14 kg). Children were monitored up to day 28 and classified according to clinical and parasitological outcome as adequate clinical and parasitological response (ACPR), early treatment failure (ETF), late clinical failure (LCF), or late parasitological failure (LPF). For P. falciparum malaria, polymerase chain reaction (PCR)-corrected treatment failure rates up to day 28 ranged between 10.3% and 28.8% for AQ plus SP and between 5.6% and 28.6% for CQ plus SP, depending on the region and the year of assessment. Overall treatment failure rate with AQ or CQ plus SP for P. vivax malaria was 12%. Our results suggest that the current first-line treatment in Papua New Guinea is not sufficiently effective. According to the new WHO guidelines for the treatment of malaria, a rate of parasitological resistance greater than 10% in the two dominant malaria species in the country justifies a change in treatment policy.
Authors:
Jutta Marfurt; Ivo Müeller; Albert Sie; Peter Maku; Mary Goroti; John C Reeder; Hans-Peter Beck; Blaise Genton
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of tropical medicine and hygiene     Volume:  77     ISSN:  1476-1645     ISO Abbreviation:  Am. J. Trop. Med. Hyg.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-06     Completed Date:  2008-05-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370507     Medline TA:  Am J Trop Med Hyg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  947-54     Citation Subset:  AIM; IM    
Affiliation:
Department of Medical Parasitology and Infection Biology, Swiss Tropical Institute, Basel, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Amodiaquine / administration & dosage*,  therapeutic use
Animals
Antimalarials / administration & dosage,  therapeutic use
Child
Child, Preschool
Chloroquine / administration & dosage*,  therapeutic use
Drug Combinations
Drug Resistance
Female
Humans
Malaria, Falciparum / drug therapy*,  epidemiology
Malaria, Vivax / drug therapy*,  epidemiology
Male
Papua New Guinea / epidemiology
Plasmodium falciparum / drug effects*
Plasmodium vivax / drug effects*
Pyrimethamine / administration & dosage*,  therapeutic use
Sulfadoxine / administration & dosage*,  therapeutic use
Chemical
Reg. No./Substance:
0/Antimalarials; 0/Drug Combinations; 2447-57-6/Sulfadoxine; 37338-39-9/sulfadoxine-pyrimethamine; 54-05-7/Chloroquine; 58-14-0/Pyrimethamine; 86-42-0/Amodiaquine

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


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