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Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan.
Trop Med Int Health. 2005 Jun; 10(6):521-9.TM

Abstract

INTRODUCTION

In South and Central Asia resistance to chloroquine (CQ) has reached unmanageable levels, and resistance to sulfadoxine-pyrimethamine (SP) is emerging. Amodiaquine (AQ) is widely used in the region, and elsewhere shows only partial resistance to CQ. In Afghanistan, one option for slowing the spread of resistance and improving treatment outcomes is the use of artemisinin combination therapy (ACT).

METHODS

The efficacy of CQ, AQ, SP and amodiaquine plus artesunate (AQ/AS) in the treatment of uncomplicated falciparum malaria was investigated using standard World Health Organization (WHO) procedures. Malaria patients were randomized to four treatment groups: 268 were enrolled and 240 completed the trial.

RESULTS

There was a high level of cross-resistance between CQ and AQ resistance: adequate clinical and parasitological response by day 42 was 11% after CQ treatment and 9% after AQ treatment. The trend of treatment failure between AQ and CQ was almost identical. Cure rates were considerably improved by the addition of artesunate to AQ or by use of SP; adequate clinical and parasitological response being 72% for AQ/AS and 92% for SP. The combination of AS/AQ substantially reduced the odds of treatment failure relative to AQ monotherapy by day 42 [odds ratio (OR) = 0.03, 95% confidence interval (CI) 0.01-0.1] in addition to reducing the proportion of patients with gametocytes throughout the 42-day period. Gametocyte carriage rate was only marginally higher in the SP than in the CQ- and AQ-treated groups.

CONCLUSION

The therapeutic and parasitological cure rates with AS/AQ were inadequate, and the criteria for deploying ACT - namely to prevent further selection of drug resistance from a position of low frequency - was not met in the region. An alternative drug combination to AQ/AS is required for Afghanistan.

Authors+Show Affiliations

HealthNet International, Malaria and Leishmaniasis Control Programme, University Town, Peshawar, Pakistan.No 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

15941414

Citation

Durrani, Naeem, et al. "Efficacy of Combination Therapy With Artesunate Plus Amodiaquine Compared to Monotherapy With Chloroquine, Amodiaquine or Sulfadoxine-pyrimethamine for Treatment of Uncomplicated Plasmodium Falciparum in Afghanistan." Tropical Medicine & International Health : TM & IH, vol. 10, no. 6, 2005, pp. 521-9.
Durrani N, Leslie T, Rahim S, et al. Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan. Trop Med Int Health. 2005;10(6):521-9.
Durrani, N., Leslie, T., Rahim, S., Graham, K., Ahmad, F., & Rowland, M. (2005). Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan. Tropical Medicine & International Health : TM & IH, 10(6), 521-9.
Durrani N, et al. Efficacy of Combination Therapy With Artesunate Plus Amodiaquine Compared to Monotherapy With Chloroquine, Amodiaquine or Sulfadoxine-pyrimethamine for Treatment of Uncomplicated Plasmodium Falciparum in Afghanistan. Trop Med Int Health. 2005;10(6):521-9. PubMed PMID: 15941414.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of combination therapy with artesunate plus amodiaquine compared to monotherapy with chloroquine, amodiaquine or sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum in Afghanistan. AU - Durrani,Naeem, AU - Leslie,Toby, AU - Rahim,Sayed, AU - Graham,Kate, AU - Ahmad,Fayaz, AU - Rowland,Mark, PY - 2005/6/9/pubmed PY - 2005/6/29/medline PY - 2005/6/9/entrez SP - 521 EP - 9 JF - Tropical medicine & international health : TM & IH JO - Trop Med Int Health VL - 10 IS - 6 N2 - INTRODUCTION: In South and Central Asia resistance to chloroquine (CQ) has reached unmanageable levels, and resistance to sulfadoxine-pyrimethamine (SP) is emerging. Amodiaquine (AQ) is widely used in the region, and elsewhere shows only partial resistance to CQ. In Afghanistan, one option for slowing the spread of resistance and improving treatment outcomes is the use of artemisinin combination therapy (ACT). METHODS: The efficacy of CQ, AQ, SP and amodiaquine plus artesunate (AQ/AS) in the treatment of uncomplicated falciparum malaria was investigated using standard World Health Organization (WHO) procedures. Malaria patients were randomized to four treatment groups: 268 were enrolled and 240 completed the trial. RESULTS: There was a high level of cross-resistance between CQ and AQ resistance: adequate clinical and parasitological response by day 42 was 11% after CQ treatment and 9% after AQ treatment. The trend of treatment failure between AQ and CQ was almost identical. Cure rates were considerably improved by the addition of artesunate to AQ or by use of SP; adequate clinical and parasitological response being 72% for AQ/AS and 92% for SP. The combination of AS/AQ substantially reduced the odds of treatment failure relative to AQ monotherapy by day 42 [odds ratio (OR) = 0.03, 95% confidence interval (CI) 0.01-0.1] in addition to reducing the proportion of patients with gametocytes throughout the 42-day period. Gametocyte carriage rate was only marginally higher in the SP than in the CQ- and AQ-treated groups. CONCLUSION: The therapeutic and parasitological cure rates with AS/AQ were inadequate, and the criteria for deploying ACT - namely to prevent further selection of drug resistance from a position of low frequency - was not met in the region. An alternative drug combination to AQ/AS is required for Afghanistan. SN - 1360-2276 UR - https://www.unboundmedicine.com/medline/citation/15941414/Efficacy_of_combination_therapy_with_artesunate_plus_amodiaquine_compared_to_monotherapy_with_chloroquine_amodiaquine_or_sulfadoxine_pyrimethamine_for_treatment_of_uncomplicated_Plasmodium_falciparum_in_Afghanistan_ L2 - https://doi.org/10.1111/j.1365-3156.2005.01429.x DB - PRIME DP - Unbound Medicine ER -