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Risk associated with asymptomatic parasitaemia occurring post-antimalarial treatment.

AbstractOBJECTIVE:
Parasites may recur asymptomatically after initial clearance by antimalarial treatment. Current guidelines recommend treatment only when patients develop symptoms or at the end of follow-up. We wanted to assess prospectively the probability of becoming symptomatic and the risks of this practice.
METHODS:
We analysed data collected in 13 trials of uncomplicated paediatric malaria conducted in eight sub-Saharan African countries. These studies followed all cases of post-treatment asymptomatic parasitaemia until they developed symptoms or to the end of the 28-day follow-up period, at which time parasite genotypes were compared to pre-treatment isolates to distinguish between recrudescences and new infections.
RESULTS:
There were 425 asymptomatic recurrences after 2576 treatments with either chloroquine, sulfadoxine/pyrimethamine or amodiaquine, of which 225 occurred by day 14 and 200 between day 15 and day 28. By day 28, 42% developed fever (median time to fever = 5 days) and 30% remained parasitaemic but afebrile, while 23% cleared their parasites (outcome unknown in 4%). Young age, parasitaemia >/=500 parasites/microl; onset of parasitaemia after day 14, and treatment with amodiaquine were the main variables associated with higher risk of developing fever.
CONCLUSION:
In areas of moderate to intense transmission, asymptomatic recurrences of malaria after treatment carry a substantial risk of becoming ill within a few days and should be treated as discovered. Young children are at higher risk. The higher risk carried by cases occurring in the second half of follow-up may be explained by falling residual drug levels.
AuthorsPiero Olliaro, Loretxu Pinoges, Francesco Checchi, Michel Vaillant, Jean-Paul Guthmann
JournalTropical medicine & international health : TM & IH (Trop Med Int Health) Vol. 13 Issue 1 Pg. 83-90 (Jan 2008) ISSN: 1365-3156 [Electronic] England
PMID18291006 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antimalarials
Topics
  • Antimalarials (administration & dosage, pharmacokinetics, therapeutic use)
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Logistic Models
  • Malaria (drug therapy, parasitology, physiopathology, prevention & control)
  • Male
  • Parasitemia (drug therapy, parasitology, physiopathology, prevention & control)
  • Proportional Hazards Models
  • Risk Factors
  • Secondary Prevention

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