Document Detail


Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT.
MedLine Citation:
PMID:  21056445     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Argemone mexicana (AM), a validated herbal medicine for uncomplicated malaria, seems to prevent severe malaria without completely clearing parasites in most patients. This study, in a high transmission area of South Mali, explores whether residual parasitaemia at day 28 was associated with subsequent malaria episodes and/or anaemia. Three hundred and one patients were randomly assigned to AM or artesunate/amodiaquine as first line treatment, of whom 294 were followed up beyond the standard 28 days, to 84 days. From day 29 to day 84, there were no significant differences between treatment groups in new clinical episodes of uncomplicated malaria (0.33 vs 0.31 episodes/patient), severe malaria (< 6% per month of patients aged ≤ 5 years) or moderate anaemia (hematocrit < 24%: 1.1% in both groups at day 84). Total parasite clearance at day 28 was not correlated with incidence of uncomplicated or severe malaria or of moderate anaemia over the subsequent two months. Total parasite clearance at day 28 was not clinically important in the context of high transmission. If this finding can be confirmed, some antimalarials which are clinically effective but do not completely clear parasites could nevertheless be appropriate in high transmission areas. Such a policy could be tested as a way to delay resistance to artemisinin combination therapies.
Authors:
Merlin L Willcox; Bertrand Graz; Chiaka Diakite; Jacques Falquet; Florent Dackouo; Oumar Sidibe; Sergio Giani; Drissa Diallo
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-11-05
Journal Detail:
Title:  Transactions of the Royal Society of Tropical Medicine and Hygiene     Volume:  105     ISSN:  1878-3503     ISO Abbreviation:  Trans. R. Soc. Trop. Med. Hyg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-03     Completed Date:  2011-04-11     Revised Date:  2011-06-01    
Medline Journal Info:
Nlm Unique ID:  7506129     Medline TA:  Trans R Soc Trop Med Hyg     Country:  England    
Other Details:
Languages:  eng     Pagination:  23-31     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Antenna Technologies, Geneva, Switzerland. merlin.willcox@dphpc.ox.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Amodiaquine / administration & dosage*,  adverse effects
Antimalarials / administration & dosage*,  adverse effects
Argemone*
Artemisinins / administration & dosage*,  adverse effects
Child
Child, Preschool
Drug Combinations
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Malaria / drug therapy*,  epidemiology,  parasitology,  transmission
Male
Mali / epidemiology
Medication Adherence / statistics & numerical data
Parasitemia
Phytotherapy
Plant Preparations / administration & dosage*,  adverse effects
Pregnancy
Rural Health
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Antimalarials; 0/Artemisinins; 0/Drug Combinations; 0/Plant Preparations; 0/amodiaquine, artesunate drug combination; 86-42-0/Amodiaquine

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


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