Document Detail

Randomized comparison of amodiaquine plus sulfadoxine-pyrimethamine, artemether-lumefantrine, and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Burkina Faso.
MedLine Citation:
PMID:  17990228     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Combination antimalarial therapy is advocated to improve treatment efficacy and limit selection of drug-resistant parasites. We compared the efficacies of 3 combination regimens in Bobo-Dioulasso, Burkina Faso: amodiaquine plus sulfadoxine-pyrimethamine, which was recently shown to be highly efficacious at this site; artemether-lumefantrine, the new national first-line antimalarial regimen; and dihydroartemisinin-piperaquine (DP), a newer regimen. METHODS: We enrolled 559 patients >or=6 months of age with uncomplicated Plasmodium falciparum malaria and randomized them to the 3 regimens. We analyzed the risk of recurrent parasitemia by day 28 and day 42, both unadjusted and adjusted by PCR methods to distinguish recrudescence and new infection. RESULTS: Complete data were available for 517 (92.5%) of the enrolled subjects. Early treatment failures occurred in 5 patients treated with amodiaquine plus sulfadoxine-pyrimethamine and in 2 patients each treated with the other regimens. The day 28 risk of recurrent parasitemia, unadjusted by genotyping, was significantly higher for patients receiving artemether-lumefantrine than for patients receiving amodiaquine plus sulfadoxine-pyrimethamine (20.1% vs. 6.2%; risk difference, 13.8%; 95% confidence interval, 7.0%-20.7%) or dihydroartemisinin-piperaquine (20.1% vs. 2.2%; risk difference, 17.9%; 95% confidence interval, 11.6%-24.1%). Similar differences were seen for children <5 years of age (54% of the study population) and when outcomes were extended to 42 days. Significant differences were not seen between outcomes for patients receiving amodiaquine plus sulfadoxine-pyrimethamine and outcomes for those receiving dihydroartemisinin-piperaquine. Recrudescences were uncommon (occurring in <5% of patients) in all treatment groups. No serious adverse events were noted. CONCLUSIONS: All regimens were highly efficacious in clearing infection, but considering the risks of recurrent malaria after therapy, the amodiaquine plus sulfadoxine-pyrimethamine and dihydroartemisinin-piperaquine regimens were more efficacious than the artemether-lumefantrine regimen (the new national regimen in Burkina Faso) for the treatment of uncomplicated P. falciparum malaria.
Issaka Zongo; Grant Dorsey; Noel Rouamba; Christian Dokomajilar; Yves Séré; Philip J Rosenthal; Jean Bosco Ouédraogo
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-10-22
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  45     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-08     Completed Date:  2007-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1453-61     Citation Subset:  IM    
Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.
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MeSH Terms
Amodiaquine / administration & dosage*,  adverse effects,  therapeutic use
Antimalarials / administration & dosage,  adverse effects,  therapeutic use
Artemisinins / administration & dosage*,  adverse effects,  therapeutic use
Burkina Faso
Child, Preschool
Drug Combinations
Drug Therapy, Combination
Ethanolamines / administration & dosage*,  adverse effects,  therapeutic use
Fluorenes / administration & dosage*,  adverse effects,  therapeutic use
Malaria, Falciparum / drug therapy*
Plasmodium falciparum
Pyrimethamine / administration & dosage*,  adverse effects,  therapeutic use
Quinolines / administration & dosage*,  adverse effects,  therapeutic use
Sulfadoxine / administration & dosage*,  adverse effects,  therapeutic use
Reg. No./Substance:
0/Antimalarials; 0/Artemisinins; 0/Drug Combinations; 0/Ethanolamines; 0/Fluorenes; 0/Quinolines; 0/artemether-lumefantrine combination; 0/dihydroartemisinic acid; 2447-57-6/Sulfadoxine; 37338-39-9/sulfadoxine-pyrimethamine; 4085-31-8/piperaquine; 58-14-0/Pyrimethamine; 86-42-0/Amodiaquine

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