Abstract | OBJECTIVES: To assess the therapeutic efficacy of sulfadoxinepyrimethamine (SP) after 5 years of use as first-line treatment of uncomplicated Plasmodium falciparum malaria, and thus guide the selection of artemisinin-based combination therapy in Mpumalanga, South Africa. DESIGN: An open-label, in vivo therapeutic efficacy study of patients with uncomplicated P. falciparum malaria treated with a single oral dose of SP, with response to treatment monitored clinically and parasitologically on days 1, 2, 3, 7, 14, 21, 28 and 42. SETTING: Mangweni and Naas public health care clinics, Tonga district in rural Mpumalanga. SUBJECTS, OUTCOME MEASURES AND RESULTS: Of 152 patients recruited sequentially, 149 (98%) were successfully followed up for 42 days. One hundred and thirty-four patients (90%) demonstrated adequate clinical and parasitological response. Of the 15 patients (10%) who failed treatment, 2 (1.3%) had an early treatment failure, and polymerase chain reaction confirmed recrudescent infection in all 13 patients (8.7%) who had late parasitological (N = 11) or clinical (N = 2) failure. Gametocyte carriage was prevalent following SP treatment (84/152) and this has increased significantly since implementation in 1998 (relative risk 2.77 (confidence interval 1.65 - 4.66); p = 0.00004). CONCLUSION: Asexual P. falciparum parasites in Mpumalanga remain sensitive to SP, with no significant difference between the baseline cure rate (94.5%) at introduction in 1998, and the present 90% cure rate (p = 0.14). However, since gametocyte carriage has increased significantly we recommend that SP be combined with artesunate in Mpumalanga to reduce gametocyte carriage and thus decrease malaria transmission and potentially delay antimalarial resistance.
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Authors | A Mabuza, J Govere, K La Grange, N Mngomezulu, E Allen, A Zitha, F Mbokazi, D Durrheim, K Barnes |
Journal | South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
(S Afr Med J)
Vol. 95
Issue 5
Pg. 346-9
(May 2005)
ISSN: 0256-9574 [Print] South Africa |
PMID | 15931450
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antimalarials
- Drug Combinations
- fanasil, pyrimethamine drug combination
- Sulfadoxine
- Pyrimethamine
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Topics |
- Adolescent
- Adult
- Animals
- Antimalarials
(therapeutic use)
- Child
- Drug Combinations
- Female
- Humans
- Malaria, Falciparum
(drug therapy, epidemiology)
- Male
- Plasmodium falciparum
(drug effects)
- Prevalence
- Pyrimethamine
(therapeutic use)
- South Africa
(epidemiology)
- Sulfadoxine
(therapeutic use)
- Treatment Outcome
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