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Drug-resistant malaria is spreading in Africa. The few available drugs might be safeguarded if combined with an artemisinin derivative. We investigated the efficacy, safety, and tolerability of 2 combinations of artesunate with sulfadoxine-pyrimethamine (SP) in a mesoendemic region in Uganda with SP resistance, from September 1999 to June 2000. In a randomized, double-blind, placebo-controlled trial, 420 children aged 6-59 months with uncomplicated Plasmodium falciparum malaria were assigned SP alone (25 mg/kg sulfadoxine, 1.25 mg/kg pyrimethamine) or combined with artesunate (AS; 4 mg/kg/d) for either 1 d (SPAS1) or 3 d (SPAS3). Children were followed-up for 28 d. Day 14 cure rates were 84.6% (99/117) with SPAS3 and 61.9% (73/118) with SPAS1 compared with 55.8% (86/154) with SP. Corresponding day 28 results were 74.4% (87/117) and 45.2% (52/115) compared with 40.5% (62/153). A significant improvement was obtained with the addition of 3 d, but not 1 d, of artesunate (risk ratio [RR] = 1.5, 95% CI 1.3-1.8 at 14 d and RR = 1.8, 95% CI 1.5-2.3 at 28 d). Both AS regimens achieved significantly faster parasite clearance and lower gametocyte carriage. All drug regimens were well tolerated, but SP alone was ineffective. Treatment efficacy improved with SPAS3 but the cure rate at day 28 was modest. The combinations were well tolerated and safe. In areas where SP resistance is prevalent other combinations should be considered.

Original publication

DOI

10.1016/s0035-9203(03)90161-1

Type

Journal

Transactions of the Royal Society of Tropical Medicine and Hygiene

Publication Date

05/2003

Volume

97

Pages

325 - 330

Addresses

Epicentre, 8 rue Saint Sabin, 75011 Paris, France. gpriotto@epicentre.msf.org

Keywords

Humans, Parasitemia, Malaria, Falciparum, Sulfadoxine, Sesquiterpenes, Artemisinins, Pyrimethamine, Drug Combinations, Antimalarials, Treatment Outcome, Drug Therapy, Combination, Follow-Up Studies, Double-Blind Method, Drug Resistance, Child, Preschool, Infant, Female, Male, Artesunate