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Randomized comparison of chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in the Lao People's Democratic Republic.
Clin Infect Dis. 2004 Oct 15; 39(8):1139-47.CI

Abstract

BACKGROUND

Recent clinical trials in the Lao People's Democratic Republic have demonstrated that chloroquine and sulfadoxine-pyrimethamine, which are national malaria treatment policy, are no longer effective in the treatment of uncomplicated Plasmodium falciparum malaria.

METHODS

A randomized comparison of 3 oral antimalarial combinations--chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine--with 42-day follow-up period, was conducted among 330 patients with acute uncomplicated falciparum malaria in southern Laos.

RESULTS

The 42-day cure rates, as determined by intention-to-treat analysis and adjusted for reinfection, were 100%, 97%, and 93% for the groups receiving artesunate plus mefloquine, artemether-lumefantrine, and chloroquine plus sulfadoxine-pyrimethamine, respectively. Of 8 patients receiving chloroquine plus sulfadoxine-pyrimethamine who experienced treatment failure, 6 had early treatment failure. The mean parasite clearance time was significantly longer in patients treated with chloroquine plus sulfadoxine-pyrimethamine (2.9 days; 95% confidence interval [CI], 2.8-3.0 days) than in those treated with artesunate plus mefloquine (2.07 days; 95% CI, 2.0-2.1 days; P<.001) and artemether-lumefantrine (2.08 days; 95% CI, 2.0-2.1 days; P<.001). Cure rates with artemether-lumefantrine were high despite low mean daily dietary fat intake (13.8 g; 95% CI, 12.5-15.1 g) and day 7 plasma lumefantrine concentrations (0.47 mu g/mL; 95% CI, 0.38-0.56 mu g/mL).

CONCLUSION

Oral artesunate plus mefloquine and artemether-lumefantrine are highly effective for the treatment of uncomplicated falciparum malaria in Laos.

Authors+Show Affiliations

Wellcome Trust-Mahosot Hospital, Oxford Tropical Medicine Research Collaboration, Vientiane, Lao PDR.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15486837

Citation

Mayxay, Mayfong, et al. "Randomized Comparison of Chloroquine Plus Sulfadoxine-pyrimethamine Versus Artesunate Plus Mefloquine Versus Artemether-lumefantrine in the Treatment of Uncomplicated Falciparum Malaria in the Lao People's Democratic Republic." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 39, no. 8, 2004, pp. 1139-47.
Mayxay M, Khanthavong M, Lindegårdh N, et al. Randomized comparison of chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in the Lao People's Democratic Republic. Clin Infect Dis. 2004;39(8):1139-47.
Mayxay, M., Khanthavong, M., Lindegårdh, N., Keola, S., Barends, M., Pongvongsa, T., Yapom, R., Annerberg, A., Phompida, S., Phetsouvanh, R., White, N. J., & Newton, P. N. (2004). Randomized comparison of chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in the Lao People's Democratic Republic. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 39(8), 1139-47.
Mayxay M, et al. Randomized Comparison of Chloroquine Plus Sulfadoxine-pyrimethamine Versus Artesunate Plus Mefloquine Versus Artemether-lumefantrine in the Treatment of Uncomplicated Falciparum Malaria in the Lao People's Democratic Republic. Clin Infect Dis. 2004 Oct 15;39(8):1139-47. PubMed PMID: 15486837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized comparison of chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in the Lao People's Democratic Republic. AU - Mayxay,Mayfong, AU - Khanthavong,Maniphone, AU - Lindegårdh,Niklas, AU - Keola,Siamphay, AU - Barends,Marion, AU - Pongvongsa,Tiengkham, AU - Yapom,Ratsuda, AU - Annerberg,Anna, AU - Phompida,Samlane, AU - Phetsouvanh,Rattanaxay, AU - White,Nicholas J, AU - Newton,Paul N, Y1 - 2004/09/27/ PY - 2004/02/10/received PY - 2004/05/25/accepted PY - 2004/10/16/pubmed PY - 2006/6/2/medline PY - 2004/10/16/entrez SP - 1139 EP - 47 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 39 IS - 8 N2 - BACKGROUND: Recent clinical trials in the Lao People's Democratic Republic have demonstrated that chloroquine and sulfadoxine-pyrimethamine, which are national malaria treatment policy, are no longer effective in the treatment of uncomplicated Plasmodium falciparum malaria. METHODS: A randomized comparison of 3 oral antimalarial combinations--chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine--with 42-day follow-up period, was conducted among 330 patients with acute uncomplicated falciparum malaria in southern Laos. RESULTS: The 42-day cure rates, as determined by intention-to-treat analysis and adjusted for reinfection, were 100%, 97%, and 93% for the groups receiving artesunate plus mefloquine, artemether-lumefantrine, and chloroquine plus sulfadoxine-pyrimethamine, respectively. Of 8 patients receiving chloroquine plus sulfadoxine-pyrimethamine who experienced treatment failure, 6 had early treatment failure. The mean parasite clearance time was significantly longer in patients treated with chloroquine plus sulfadoxine-pyrimethamine (2.9 days; 95% confidence interval [CI], 2.8-3.0 days) than in those treated with artesunate plus mefloquine (2.07 days; 95% CI, 2.0-2.1 days; P<.001) and artemether-lumefantrine (2.08 days; 95% CI, 2.0-2.1 days; P<.001). Cure rates with artemether-lumefantrine were high despite low mean daily dietary fat intake (13.8 g; 95% CI, 12.5-15.1 g) and day 7 plasma lumefantrine concentrations (0.47 mu g/mL; 95% CI, 0.38-0.56 mu g/mL). CONCLUSION: Oral artesunate plus mefloquine and artemether-lumefantrine are highly effective for the treatment of uncomplicated falciparum malaria in Laos. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/15486837/Randomized_comparison_of_chloroquine_plus_sulfadoxine_pyrimethamine_versus_artesunate_plus_mefloquine_versus_artemether_lumefantrine_in_the_treatment_of_uncomplicated_falciparum_malaria_in_the_Lao_People's_Democratic_Republic_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/424512 DB - PRIME DP - Unbound Medicine ER -