Treatment Of Malaria In Children Research Articles

Comparison of the efficacy of artesunate-amodiaquine with quinine ... clindamycin for treatment of uncomplicated falciparum malaria in children

Background Drug-resistant Plasmodium falciparum malaria is amajor contributor to increasing malaria-related morbidity andmortality. Artesunate-amodiaquine is a potential combinationtherapy that shows improved treatment efficacy. Clindamycin incombination with quinine is also a safe and effective treatmentfor multidrug-resistant P. falciparum malaria.Objectives To compare the efficacy of artesunate-amodiaquine andquinine-clindamycin combination therapies for the treatment ofuncomplicated falciparum malaria.Methods This randomized open label trial in 23 2 children agedbetween one month and 18 years old took place in MandailingNatal, North Sumatra, from August to September 2006. The AAgroup received a 3-day oral course of artesunate (4 mg/kg BWonce a day) plus amodiaquine (10 mg/kg BW once a day). TheQC group received a 3-day course of clindamycin (5 mg of base/kgBW twice a day) plus a 7-day course of quinine (10 mg of salt/kgBW orally for the first four days, then 5 mg of quinine salt/kg BWfor the next three days). We performed thin and thick peripheralblood smears on days 0, 2, 7, and 28.Results A total of 232 eligible children were enrolled but only22 7 completed the study (114 in group AA, 113 in group QC).The cure rates were lOOo/o in both groups by the second day, andthere was no recrudescence in either group. We found more sideeffects in AA group compared with in QC group, i.e., headacheand vomiting.Conclusion Artesunate-amodiaquine and quinine-clindamycincombinations showed similar efficacy for the treatment of uncomplicatedP. falciparum.

Abandoning Presumptive Antimalarial Treatment for Febrile Children Aged Less Than Five Years—A Case of Running Before We Can Walk?

Background to the debate: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five.

Time To Move from Presumptive Malaria Treatment to Laboratory-Confirmed Diagnosis and Treatment in African Children with Fever

Background to the debate: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five.

A randomized, open-label, comparative efficacy trial of artemether-lumefantrine suspension versus artemether-lumefantrine tablets for treatment of uncomplicated Plasmodium falciparum malaria in children in western Kenya

BackgroundArtemether/lumefantrine (AL) has been adopted as the treatment of choice for uncomplicated malaria in Kenya and other countries in the region. Six-dose artemether/lumefantrine tablets are highly effective and safe for the treatment of infants and children weighing between five and 25 kg with uncomplicated Plasmodium falciparum malaria. However, oral paediatric formulations are urgently needed, as the tablets are difficult to administer to young children, who cannot swallow whole tablets or tolerate the bitter taste of the crushed tablets.MethodsA randomized, controlled, open-label trial was conducted comparing day 28 PCR corrected cure-rates in 245 children aged 6–59 months, treated over three days with either six-dose of artemether/lumefantrine tablets (Coartem®) or three-dose of artemether/lumefantrine suspension (Co-artesiane®) for uncomplicated falciparum malaria in western Kenya. The children were followed-up with clinical, parasitological and haematological evaluations over 28 days.ResultsNinety three percent (124/133) and 90% (121/134) children in the AL tablets and AL suspension arms respectively completed followed up. A per protocol analysis revealed a PCR-corrected parasitological cure rate of 96.0% at Day 28 in the AL tablets group and 93.4% in the AL suspension group, p = 0.40. Both drugs effectively cleared gametocytes and were well tolerated, with no difference in the overall incidence of adverse events.ConclusionThe once daily three-dose of artemether-lumefantrine suspension (Co-artesiane®) was not superior to six-dose artemether-lumefantrine tablets (Coartem®) for the treatment of uncomplicated malaria in children below five years of age in western Kenya.Trial registrationClinicalTrials.gov NCT00529867

Spotlight on malaria: MAM2008

Since the first Molecular Approaches to Malaria meeting in 2000 (MAM2000) in Lorne, Australia, Trends in Parasitology has published a Special Issue as an accompaniment. It gives us great pleasure to write the foreword for the third Special Issue in this series, to complement MAM2008.The burden of malaria on human health remains unacceptably large and we are still, in many ways, far from having a complete understanding of the mechanisms by which the parasites cause disease and death. Advances in chemotherapy regimes, impregnated bed nets and efficiencies in delivery programs are making real strides, and this gives welcome breathing space to vaccine development efforts – which, unfortunately, are taking longer than expected. Sadly, despite considerable and important progress in this regard, a highly effective vaccine is not even on the horizon and, perhaps, we still have unrealistic expectations.Notwithstanding these downsides, our knowledge of the epidemiology of malaria parasites, their impact on human health, and the mechanisms of malaria metabolism and pathogenesis continues to increase. This Special Edition is testament to that and includes reviews on several important aspects of malaria, reflecting not only the breadth of topics covered by this very successful conference but also where recent progress has perhaps been most vanguard.This issue reviews several fundamentally important areas including evolutionary genomics, mechanisms of gene regulation, exploration of the kinome of the parasites, pre-erythrocytic-stage biology, parasite invasion, molecular-based field studies, chemotherapy and drug resistance, the prevention and treatment of severe malaria in children and during pregnancy, and immunity and vaccines. Society’s renewed demand for the eradication of malaria provides a significant driver for our continued advancement in these, as well as all other, aspects of malaria research.

Drug utilisation study of antimalarials for the treatment of hospitalised children under five in south‐eastern Nigeria

This study aimed at describing the trend in the use of antimalarials for the treatment of malaria in children under 5 years from year 2000 to 2006 in south-eastern Nigeria. Adherence to the 2005 National Antimalarial Treatment Policy was assessed. Quality of drug use was also evaluated. Quality indices studied were the use of international non-proprietary name (INN) in prescription, number antimalarials per episode and use of drugs from essential drug list. The study was retrospective and longitudinal, using data obtained from in-patients folders of children under 5 years, hospitalised for malaria infection in 11 secondary health care centres in south-eastern Nigeria. The result of the study showed that chloroquine was mostly used for treating severe malaria in children less than 5 years despite the indication of a switch to quinine and parenteral artemisinins by the National Treatment Policy. Prescriptions of drugs were also not by INN names. However, many prescribers do not practice polypharmacy and most of the drugs used in secondary health care centres for treatment of severe malaria were in the essential drug list. There is a need for further studies to establish factors that affect the dissemination and use of treatment guidelines in Nigeria.

Comparative efficacy of artesunate and sulphadoxine-pyrimethamine combination with artesunate and amodiaquine combination in uncomplicated falciparum malaria in children

Background Malaria is still an important cause of mortality and morbidity in children and adults in tropical countries. Multidrug resistance againts chloroquine and sulphadox- ine-pyrimethamine had brought to an introduction of artemisinin-based combination. Objective To assess the alternative treatment of uncompli- cated falciparum malaria in children using artesunate and sulphadoxine-pyrimethamine combination comparing to artesunate and amodiaquine combination. Methods This is a single-blind randomized trial. Sixty- seven children aged six months to 13 years, were recruited. Thirty-three children were treated with artesunate 4 mg/ kgbw/day for three days with an additional sulphadoxine- pyrimethamine (pyrimethamine 1-1.5 mg/kgbw) single dose on the first day, while 34 children were treated with artesunate and amodiaquine base 10 mg/kgbw/day for the first two days, then 5 mg/kgbw/day on the third day. Body temperature and parasite count were recorded everyday for at least seven days. The outcomes were fever clearance time, parasite clearance time, cure rate and side effects. Sta- tistical analysis was performed using the student t-test. Results The statistical analysis showed that there were no difference between these two groups either in fever clearance time (P>0.05), or in parasite clearance time (P>0.05). The cure rate was 100% in both groups. Vomit- ing was found in one patient treated with artesunate and amodiaquine combination. Conclusion The combination of artesunate and sulpha- doxine-pyrimethamine and combination of artesunate and amodiaquine were found to be equally effective in the treatment of uncomplicated falciparum malaria in children

Therapy of uncomplicated malaria in children: a review of treatment principles, essential drugs and current recommendations

Understanding the optimal treatment of uncomplicated malaria in children is challenging because of the availability of new drugs and the shift to combination therapies. This is a review of the guiding principles for the treatment of uncomplicated malaria, the essential anti-malarial drugs for children, and the treatment regimens currently recommended.

Operational issues and trends associated with the pilot introduction of zinc for childhood diarrhoea in Bougouni district, Mali.

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas.

A randomised trial to assess the efficacy and safety of chlorproguanil/dapsone + artesunate for the treatment of uncomplicated Plasmodium falciparum malaria

We tested the efficacy and safety of chlorproguanil/dapsone co-administered with artesunate (CD+A) for the treatment of uncomplicated Plasmodium falciparum malaria in children compared with amodiaquine+sulfadoxine/pyrimethamine (AQ+SP) at two different sites in Rwanda. The trial was open label and 800 patients were randomly assigned to AQ+SP (n=400) or CD+A (n=400). Patients were hospitalised for 3 days and then followed-up weekly until Day 28 after treatment. Clinical and parasitological outcomes were recorded. Results showed that neither treatment was adequately efficacious. At one site, the adequate clinical and parasitological response (ACPR), PCR-adjusted, was 73.3% in the CD+A arm and 87.8% in the AQ+SP arm (P<0.001), and at the second site the ACPR, PCR-adjusted, was 70.5% in the CD+A arm and 38.1% in the AQ+SP arm (P<0.001). The combination CD+A is considered an alternative to, or replacement for, SP in Africa because CD has been shown to be effective in patients for whom SP treatment has failed and, with its short half-life, it is expected to exert less selection pressure for resistant parasites than SP. However, the results of this trial indicate that in an area of high SP resistance, CD+A may not be the best choice.

Mothers' perception and management of childhood malaria in Umuahia South Local Government Area, Abia State, Nigeria

The survey was designed to study mothers' perception and management of childhood malaria in Umuahia South Local Government Area of Abia State, Nigeria, due to the observation that malaria associated childhood morbidity and mortality continued to be on the increase in the area despite availability of new drugs and techniques for malaria control. One thousand, seven hundred and twenty-eight (1,728) mothers of different socio-economic background and between the ages of 30-59 years were randomly selected from the local government area and interviewed on the etiology, symptoms, management and treatment of childhood malaria in the area. Results obtained showed that both knowledge of the etiology and symptoms as well as management of malaria in children by mothers were still poor. About 30% neither knew the cause of the disease nor its major symptoms. Management practices were majorly based on self-medication with modern drugs obtained from mostly sub-standard chemist stores. When the home treatment failed, as many as 47.2% of the mothers did not take their wards to the hospital but continued the same treatment or sent them to prayer-houses and herbalists. While occupation, educational level and age of the mother affected correct knowledge of the etiology at 5% significant level, they had no significant (p>0.05) impact on recognition of the correct symptoms and choosing of first line treatment by mothers. Control of mosquitoes was mainly by use of sprays or burning of herbs, only about 13.4% used bed nets. Aside from enhanced awareness campaign in the area, there may be need for the Roll Back Malaria Implementation Committee and other stakeholders to consider other options like subsidizing the prices of effective malaria drugs or giving them free to mothers for their sick children, as is the case with other deadly childhood diseases. Keywords : childhood malaria, morbidity, mortality, etiology and symptoms, self-medication, Nigeria. Nigerian Journal of Parasitology Vol. 28 (2) 2007: pp. 55-60

Enhanced Efficacy of Amodiaquine and Chlorpheniramine Combination over Amodiaquine Alone in the Treatment of Acute Uncomplicated Plasmodium falciparum Malaria in Children

Objective: To evaluate the comparative efficacy of amodiaquine (AMQ) alone and the combination of AMQ and chlorpheniramine (CP) in the treatment of acute uncomplicated malaria in children. Subjects: Of the 110 children enrolled in the study, 103 with acute uncomplicated malaria, aged 6 months to 12 years, were evaluated using the 14-day modification of the WHO field test. The patients were randomized to 2 groups. Group 1 received supervised treatment with AMQ alone (10 mg AMQ base/kg daily for 3 days), while group 2 received supervised treatment with AMQ (same dose as group 1) plus CP (AMQCP) for 7 days. Results: Both treatment regimens were well tolerated and no patient was withdrawn as a result of recurrent vomiting or drug-related adverse events. There was no significant difference in mean fever and parasite clearance times. The cure rates at day 7 were 90.2 versus 100% (ρ = 0.027) for AMQ versus AMQCP, while the day 14 cure rates were 85.9 versus 98.1% for AMQ versus AMQCP, respectively (ρ = 0.016). Conclusion: The combination of AMQ plus CP proved significantly more effective than AMQ alone in the treatment of acute uncomplicated falciparum malaria, most probably due to the enhancement of the antimalarial effect of AMQ by CP. The combination of AMQCP could be a better alternative to AMQ alone as a companion drug in artemisinin-based combination therapies.

COMBINATION OF ARTESUNATE-AMODIAQUINE AS A TREATMENT FOR UNCOMPLICATED FALCIPARUM MALARIA IN CHILDREN

INTRODUCTION: Resistance of falciparum malaria to both chloroquine and pyrimethamine-sulfadoxine has been reported from Indonesia and other countries. Since the end of 2004, we have changed the standard treatment of uncomplicated falciparum malaria to use a combination of artesunate and amodiaquine. OBJECTIVE: Our aim was to evaluate the efficacy and adverse reactions of artesunate-amodiaquine as a treatment for uncomplicated falciparum malaria in children. METHODS: We conducted a cross-sectional study at Panyabungan, Mandailing Natal Regency, North Sumatera Province, Indonesia, from August to September 2006. The sample was school-aged children between 5 and 18 years old. The sample received an oral dose of artesunate (4 mg/kg body weight) combined with an oral dose of amodiaquine (10 mg/kg body weight) for 3 days. Parasitemia was assessed at days 0, 2, 7, and 28. RESULTS: Peripheral blood smears were performed for 376 school-aged children; 135 of them tested positive for falciparum malaria. At the end of the study (28 days), 121 cases completed a full course of study. From the peripheral blood smears on days 2, 7, and 28, we found a 100% cure rate. Adverse reactions included 20 children (16.5%) with headache, 10 (8.3%) with vomiting, and 1 (0.8%) with tinnitus. CONCLUSIONS: A combination of artesunate and amodiaquine can be used as treatment for uncomplicated falciparum malaria in children with the caution of headache as an adverse reaction of the drug combination.

Effect of iron and zinc supplementation in the treatment of malaria in children

Background Iron and zinc administration for children withmalaria in endemic area were known to decrease parasitemia butdata on their effectiveness when given together to increasereticulocytes as erythropoiesis parameter and hemoglobin isinsufficient.Objective To determine the effect of zinc to increase ironabsorption in the treatment of Plasmodium falciparum malaria inchildren.Methods Children with positive Plasmodium falciparum on theirblood smear (n=86) examination were randomly assigned to dailysupplementation of iron 6 mg per kg body weight per day plusplacebo or iron plus zinc 10 mg per day for 30 days. Venous bloodspecimens were collected at the start and at the end of the study.Results Sixty-nine children completed the supplementations andhad both baseline and follow-up blood specimen study. After 30-day supplementation, the iron plus placebo and iron plus zincgroups showed significant difference on hemoglobin concentration(0.58 and 0.09 g/dl; P&lt;0.05). There was no significant differencein reticulocyte production index and reticulocyte count beforeand after intervention in both groups. There was only significantdifference in red blood cells concentration after supplementationof iron plus placebo and iron plus zinc (4.7 in 4.5 million/μl;P&lt;0.05).Conclusions Iron supplementation with or without zinc showssignificant increase of hemoglobin concentration. It is slightlyhigher in iron plus placebo group.

Efficacy and safety of artemisinin-based antimalarial in the treatment of uncomplicated malaria in children in southern Tanzania

BackgroundTanzania switched the antimalarial first line to sulphadoxine-pyrimethamine (SP) in 2001 from ineffective chloroquine (CQ). By 2003 higher levels of SP resistance were recorded, prompting an urgent need for replacing the first line drug with ACT, as currently recommended by the World Health Organization. Despite this recommendation country-specific evidence-based data to support efficacy and safety profile of ACT is still limited. A study on the efficacy and safety of artesunate plus amodiaquine (AS+AQ) and artemether plus lumefantrine (AL)(Coartem®) was carried out in 2004 with the view of supporting the National Malaria Control Programme in the review of the policy in mainland Tanzania.MethodsAn in vivo efficacy study was conducted at Ipinda and Mlimba health facilities between May and November 2004. The study recruited children aged 6–59 months presenting with symptoms of uncomplicated malaria, history of fever or an axillary temperature ≥37.5°C; mono infection with Pasmodium falciparum (2,000–200,000 parasites/μl). Patients were randomized to received either SP or amodiaquine monotherapy or treated with standard doses of AS+AQ in Mlimba and Coartem in Kyela and followed-up for 28 days to assess treatment responses. This study reports results of the combination therapies.ResultsA total of 157 children (76 in Mlimba and 99 in Kyela) who were enrolled in to the study and treated with either AL or AS+AQ were successfully followed-up. Both combinations were tolerated and effected rapid fever and parasite clearance. The crude ACPRs were 80 (87%) and 41 (63%) for AL and AS+AQ respectively. However, after PCR adjustments the corresponding figures raised to 100% (n = 86) and 93.8% (n = 45) in AL and AS+AQ groups, respectively. The mean haemoglobin improved moderately from day 0 to day 28 by 1 g/dl in AL and 0.4 g/dl in AS+AQ treatment group and was statistically significant (p < 0.001 both).ConclusionThese findings provide substantial evidence that AL is highly efficacious in areas of high resistance of SP and supported the country's decision to switch from SP monotherapy to AL.

Efficacy of artemether-lumfantrine (Co-Artesiane®) suspension in the treatment of uncomplicated Plasmodium falciparum malaria among children under 5 years in eastern Sudan

Purpose: the aim of the present study was to investigate the efficacy of artemether-lumfantrine (Co-Artesiane®) suspension for the treatment of uncomplicated Plasmodium falciparum malaria in children (aged 6-59 months) in Kassala in eastern Sudan. Method: This was a prospective clinical trial where the artemether-lumfantrine (Co-Artesiane®) suspension was given for three days and the patients were followed-up for 28 days Results: Forty-eight patients were enrolled in the study and 43 of them completed the 28-days follow-up. Treatment rapidly cleared parasitemia and fever. The overall 28-day cure rate was 100% and no clinical or parasitological failures were observed among these patients. Mild side effects were observed in three (7%) children. Conclusion: Artemether-lumfantrine (coartem) suspension appears to be efficacious and safe for the treatment of uncomplicated malaria. Keywords: Artemether-lumfantrine, Co-Artesiane, children, falciparum, malaria, Sudan> Tropical Journal of Pharmaceutical Research Vol. 5 (1) 2006: pp. 551-555

Continued efficacy of sulfadoxine–pyrimethamine as second line treatment for malaria in children in Guinea-Bissau

BackgroundSulfadoxine–pyrimethamine (S/P) is widely used for treatment of failures following the first line treatment for malaria in Africa. In Guinea-Bissau, it has been recommended as second line therapy by the National Malaria Programme since 1996. In order to monitor any change of the in vivo sensitivity, the efficacy of S/P was studied immediately before the introduction of the drug and 6–9 years later. MethodsChildren participating in clinical in vivo studies were given S/P if having late clinical treatment failure following the treatment with quinine, chloroquine, or amodiaquine. Parasitological and clinical failures were evaluated during a 35-day follow-up. During the first study period whole blood sulfadoxine concentrations were measured on day 7. ResultsAltogether, 56 children failed the initial treatment and were included in 1995/1996 as well as 55 children in 2002/2004. The PCR-uncorrected adequate clinical and parasitological response rates on day 28 were 94% and 91%, and on day 35 they were 89% and 91%, respectively, in the two periods. No difference between median blood drug concentration in children with and without treatment failure was observed. InterpretationThe efficacy of S/P as second line treatment for uncomplicated malaria has remained unchanged in spite of a relatively high level of genetic markers associated with Plasmodium falciparum resistance to S/P previously found in the area.

Different doses of amodiaquine and chloroquine for treatment of uncomplicated malaria in children in Guinea-Bissau: implications for future treatment recommendations

The aim of the present study was to compare different doses of chloroquine (CQ) and amodiaquine (AQ) for the treatment of falciparum malaria in children. Children with Plasmodium falciparum monoinfection were allocated by block randomisation to treatment with CQ 50/kg mg or 25 mg/kg or AQ 15 mg/kg or 30 mg/kg. The main outcomes were the cumulative adequate clinical and parasitological response (ACPR) rates and the number of true recrudescences as determined by PCR. A total of 729 children were included. In an evaluability analysis, the PCR-uncorrected cumulative ACPR rates on Day 28 for the treatment groups CQ 50/kg mg or 25 mg/kg and AQ 15 mg/kg or 30 mg/kg were 90%, 76%, 92% and 94%, respectively; the PCR-adjusted ACPR rates on Day 28 were 92%, 80%, 94% and 94%, respectively. No differences in adverse effects were observed. AQ has a high cure rate given as 30 mg/kg and 15 mg/kg, although it is not superior to treatment with CQ 50 mg/kg. However, 25 mg/kg of CQ is less efficient. As an interim option, Guinea-Bissau could change the recommended first-line treatment of uncomplicated malaria to CQ 50 mg/kg, reserving AQ as a partner drug for a future combination therapy.

Relationship between antipyretic effects and cytokine levels in uncomplicated falciparum malaria during different treatment regimes

We have previously shown that both chloroquine and paracetamol (acetaminophen) have antipyretic activity during treatment of acute uncomplicated Plasmodium falciparum malaria in children 1–4 years old. Here, we studied if this effect was accompanied by changes in plasma cytokine levels. The 104 children were treated with either chloroquine or sulfadoxine/pyrimethamine (SP) alone, SP + chloroquine or SP + paracetamol for 4 days. Cytokine levels were determined days 0, 2 and 3, body temperature every sixth hour until 72 h and parasitemia once daily for 4 days. At admission, body temperature correlated with levels of IL-10, IFN-γ and IL-6, and parasitemia correlated with IL-10 and IL-6. Except for TNF-α and IL-1β, where no significant effect was found, all cytokine levels (IL-10, IFN-γ, IL-6, IL-12, IL-13, IL-18 and IL-4) decreased up to day 2 ( p < 0.05). IL-6 levels continued to fall from days 2 to 3 ( p < 0.05), whereas increased levels were found for several cytokines (IL-12, IL-13, IL-18 and IL-1β) ( p < 0.05). The antipyretic effects of chloroquine and paracetamol could not be related to any specific changes in the evaluated cytokine production or in Th1/Th2 or inflammatory/anti-inflammatory cytokine ratios. Alternative mechanisms for antipyretic effects and associations between fever and cytokine levels during uncomplicated P. falciparum malaria are therefore discussed.

Comparative trial of artesunate and halofantrine in the treatment of uncomplicated malaria in children at a general hospital in Enugu

Comparative trial of artesunate and halofantrine in the treatment of uncomplicated malaria in children at a general hospital in Enugu