Abstract
BackgroundData concerning antimalarial combination treatment for uncomplicated malaria in Madagascar are largely lacking. Randomized clinical trial was designed to assess therapeutic efficacies of chloroquine (CQ), amodiaquine (AQ), sulphadoxine-pyrimethamine (SP), amodiaquine plus sulphadoxine-pyrimethamine combination (AQ+SP) and artesunate plus amodiaquine combination (AQ+AS).Methods287 children between 6 months and 15 years of age, with uncomplicated falciparum malaria, were enrolled in the study. Primary endpoints were the day-14 and day-28 risks of parasitological failure, either unadjusted or adjusted by genotyping.ResultsAll treatment regimens, except for CQ treatment, gave clinical cure rates above 97% by day-14 and 92% by day-28 (PCR-corrected). AQ+SP was as effective as AQ+AS. The risk of new infection within the month after therapy was generally higher for AQ+AS than AQ+SP.ConclusionThese findings show that the inexpensive and widely available combination AQ+SP may be valuable in for the treatment of uncomplicated malaria in Madagascar and could have an important role in this country, where much of the drugs administered go to patients who do not have malaria.
Highlights
Data concerning antimalarial combination treatment for uncomplicated malaria in Madagascar are largely lacking
Seventeen patients (5.7%) were lost to follow-up, four patients withdrew consent (1.3%) and one patient (0.3%) had to be withdrawn because he was treated outside the study with drugs active against malaria (Figure 1)
No severe side-effects attributable to the study medication were observed during the follow-up period, except that one patient treated with amodiaquine plus sulphadoxine-pyrimethamine combination (AQ+SP) developed vomiting
Summary
Data concerning antimalarial combination treatment for uncomplicated malaria in Madagascar are largely lacking. Of the available antimalarial drugs, the artemisinins are the most potent and the World Health Organization (WHO) advocates the use of artemisinin-based combination therapy (ACT) as the standard policy for the treatment of uncomplicated falciparum malaria [6]. There are concerns regarding the cost and availability of artemisinin-based combination therapy (ACT), and only limited data comparing ACT with other combination therapies in Africa are available [7]. It is unclear whether ACTs are appropriate for empirical management of febrile illnesses outside the formal health sector without laboratory confirmation, in the way that CQ and SP have been used for several years
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