The addition of artesunate to chloroquine for treatment of Plasmodium falciparum malaria in Gambian children delays, but does not prevent treatment failure

被引:26
作者
Sutherland, CJ
Drakeley, CJ
Obisike, U
Coleman, R
Jawara, M
Targett, GAT
Milligan, P
Pinder, M
Walraven, G
机构
[1] Univ London London Sch Hyg & Trop Med, Dept Infect & Trop Dis, London WC1E 7HT, England
[2] Fajara Med Res Council Labs, Banjul, Gambia
[3] Farafenni Field Stn, Farafenni, Gambia
[4] Joint Malaria Programme, Moshi, Tanzania
关键词
D O I
10.4269/ajtmh.2003.69.19
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
In a randomized controlled trial, chloroquine monotherapy was compared with the combination of artesunate and chloroquine for treating uncomplicated Plasmodium fialciparum malaria in 536 Gambian children. Chloroquine-treated children exhibited a 28-day clinical failure rate of 15% (95% confidence interval [CI] = 9.2-22%) compared with 11% (7.8-15%) among children receiving the combination (P = 0.08, by Wilcoxon test). Seventy-three percent of chloroquine-treated children exhibited parasitemia during follow-up compared with 49% of children receiving the combination (relative risk = 1.5, 95% CI - 1.3-1.7; chi(2) = 21.18, P < 0.001). A significant reduction in clinical and parasitologic treatment failure in the combination group occurred in the first two weeks following treatment, but this was eroded over weeks three and four of follow-up. The impact of combination therapy on the transmission of chloroquine-resistant parasites is discussed. Chloroquine plus artesunate is not sufficiently efficacious to justify its introduction as a replacement for chloroquine monotherapy in The Gambia.
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页码:19 / 25
页数:7
相关论文
共 22 条
[1]   Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children:: a randomised, multicentre trial [J].
Adjuik, M ;
Agnamey, P ;
Babiker, A ;
Borrmann, S ;
Brasseur, P ;
Cisse, M ;
Cobelens, F ;
Diallo, S ;
Faucher, JF ;
Garner, P ;
Gikunda, S ;
Kremsner, PG ;
Krishna, S ;
Lell, B ;
Loolpapit, M ;
Matsiegui, PB ;
Missinou, MA ;
Mwanza, J ;
Ntoumi, F ;
Olliaro, P ;
Osimbo, P ;
Rezbach, P ;
Some, E ;
Taylor, WRJ .
LANCET, 2002, 359 (9315) :1365-1372
[2]  
Collet D., 1994, MODELLING SURVIVAL D, V1st
[3]  
Dollery C., 1999, THERAPEUTIC DRUGS
[4]   Sulfadoxine/pyrimethamine alone or with amodiaquine or artesunate for treatment of uncomplicated malaria: a longitudinal randomised trial [J].
Dorsey, G ;
Njama, D ;
Kamya, MR ;
Cattamanchi, A ;
Kyabayinze, D ;
Staedke, SG ;
Gasasira, A ;
Rosenthal, PJ .
LANCET, 2002, 360 (9350) :2031-2038
[5]   The effect of artesunate combined with standard antimalarials against chloroquine-sensitive and chloroquine-resistant strains of Plasmodium faiciparum in vitro [J].
Fivelman, QL ;
Walden, JC ;
Smith, PJ ;
Folb, PI ;
Barnes, KI .
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 1999, 93 (04) :429-432
[6]   COMPARISON OF 2 SIMPLE METHODS FOR DETERMINING MALARIA PARASITE DENSITY [J].
GREENWOOD, BM ;
ARMSTRONG, JRM .
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 1991, 85 (02) :186-188
[7]   Mathematical modelling of the chemotherapy of Plasmodium falciparum malaria with artesunate:: postulation of 'dormancy', a partial cytostatic effect of the drug, and its implication for treatment regimens [J].
Hoshen, MB ;
Na-Bangchang, K ;
Stein, WD ;
Ginsburg, H .
PARASITOLOGY, 2000, 121 :237-246
[8]   A NATIONAL SURVEY OF THE PREVALENCE OF CHLOROQUINE RESISTANT PLASMODIUM-FALCIPARUM MALARIA IN THE GAMBIA [J].
MENON, A ;
OTOO, LN ;
HERBAGE, EA ;
GREENWOOD, BM .
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 1990, 84 (05) :638-640
[9]   A randomized trial of chloroquine, amodiaquine and pyrimethamine-sulphadoxine in Gambian children with uncomplicated malaria [J].
Muller, O ;
vanHensbroek, MB ;
Jaffar, S ;
Drakeley, C ;
Okorie, C ;
Joof, D ;
Pinder, M ;
Greenwood, B .
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 1996, 1 (01) :124-132
[10]   Efficacy of sulphadoxine-pyrimethamine for acute uncomplicated malaria due to Plasmodium falciparum in Malawian children under five years old [J].
Nwanyanwu, OC ;
Ziba, C ;
Macheso, A ;
Kazembe, P .
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2000, 5 (05) :355-358