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Continued efficacy of sulfadoxine-pyrimethamine as second line treatment for malaria in children in Guinea-Bissau.

AbstractBACKGROUND:
Sulfadoxine-pyrimethamine (S/P) is widely used for treatment of failures following the first line treatment for malaria in Africa. In Guinea-Bissau, it has been recommended as second line therapy by the National Malaria Programme since 1996. In order to monitor any change of the in vivo sensitivity, the efficacy of S/P was studied immediately before the introduction of the drug and 6-9 years later.
METHODS:
Children participating in clinical in vivo studies were given S/P if having late clinical treatment failure following the treatment with quinine, chloroquine, or amodiaquine. Parasitological and clinical failures were evaluated during a 35-day follow-up. During the first study period whole blood sulfadoxine concentrations were measured on day 7.
RESULTS:
Altogether, 56 children failed the initial treatment and were included in 1995/1996 as well as 55 children in 2002/2004. The PCR-uncorrected adequate clinical and parasitological response rates on day 28 were 94% and 91%, and on day 35 they were 89% and 91%, respectively, in the two periods. No difference between median blood drug concentration in children with and without treatment failure was observed.
INTERPRETATION:
The efficacy of S/P as second line treatment for uncomplicated malaria has remained unchanged in spite of a relatively high level of genetic markers associated with Plasmodium falciparum resistance to S/P previously found in the area.
AuthorsPoul-Erik Kofoed, Amabelia Rodrigues, Peter Aaby, Lars Rombo
JournalActa tropica (Acta Trop) Vol. 100 Issue 3 Pg. 213-7 (Dec 2006) ISSN: 0001-706X [Print] Netherlands
PMID17173847 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antimalarials
  • Drug Combinations
  • Tablets
  • Sulfadoxine
  • Pyrimethamine
Topics
  • Adolescent
  • Animals
  • Antimalarials (administration & dosage)
  • Child
  • Child, Preschool
  • Drug Combinations
  • Female
  • Guinea-Bissau
  • Humans
  • Infant
  • Malaria, Falciparum (drug therapy, metabolism)
  • Male
  • Parasitemia
  • Plasmodium falciparum
  • Pyrimethamine (administration & dosage)
  • Sulfadoxine (administration & dosage, pharmacokinetics)
  • Tablets (administration & dosage)
  • Treatment Failure
  • Urban Population

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