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Comparative efficacy of aminoquinoline-antifolate combinations for the treatment of uncomplicated falciparum malaria in Kampala, Uganda.

Abstract
Resistance to chloroquine (CQ) requires its replacement as first-line therapy for uncomplicated malaria in much of Africa. Combination therapy may improve efficacy and delay the selection of resistant malaria parasites. Combinations of sulfadoxine-pyrimethamine (SP) with 4-aminoquinolines offer affordable and available alternatives to CQ. We conducted a randomized, single-blinded trial to compare the efficacy of SP monotherapy with combinations of SP and either CQ or amodiaquine (AQ) for the treatment of uncomplicated falciparum malaria in patients over 6 months of age in Kampala, Uganda. Of the 448 patients enrolled, 428 (95%) completed follow-up. Clinical treatment failure after 14 days occurred in 21/140 (15.0%, 95% CI 9.5-22.0%) SP-treated, 11/152 (7.2%, 95% CI 3.7-12.6%) SP/CQ-treated, and 0/136 (0%, 95% CI 0-2.7%) SP/AQ-treated patients. Combination therapies were safe and offered superior efficacy to SP monotherapy. SP/AQ was the most efficacious. This low-cost combination regimen may provide an optimal alternative to CQ for the treatment of uncomplicated malaria in Uganda.
AuthorsAnne F Gasasira, Grant Dorsey, Bridget Nzarubara, Sarah G Staedke, Annette Nassali, Philip J Rosenthal, Moses R Kamya
JournalThe American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 68 Issue 2 Pg. 127-32 (Feb 2003) ISSN: 0002-9637 [Print] United States
PMID12641399 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Antimalarials
  • Drug Combinations
  • Amodiaquine
  • fanasil, pyrimethamine drug combination
  • Sulfadoxine
  • Chloroquine
  • Pyrimethamine
Topics
  • Adolescent
  • Adult
  • Amodiaquine (administration & dosage, therapeutic use)
  • Antimalarials (administration & dosage, therapeutic use)
  • Child
  • Child, Preschool
  • Chloroquine (administration & dosage, therapeutic use)
  • Drug Combinations
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infant
  • Malaria, Falciparum (drug therapy)
  • Male
  • Middle Aged
  • Pyrimethamine (administration & dosage, therapeutic use)
  • Single-Blind Method
  • Sulfadoxine (administration & dosage, therapeutic use)
  • Treatment Outcome
  • Uganda

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