Free Content Antimalarial efficacy of sulfadoxine–pyrimethamine, amodiaquine and a combination of chloroquine plus sulfadoxine–pyrimethamine in Bundi Bugyo, western Uganda

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Abstract:

Summary

We report below an in vivo antimalarial efficacy study conducted in 2002 in Bundi Bugyo, a district of western Uganda housing a large displaced population. We tested sulfadoxine–pyrimethamine (SP), amodiaquine (AQ) and the combination chloroquine plus SP (CQ + SP). A total of 268 children with uncomplicated Plasmodium falciparum malaria were followed-up for 28 days according to WHO recommendations, with PCR genotyping to distinguish late recrudescences from re-infections. PCR-adjusted failure proportions at day 28 were 37.0% (34/92, 95% CI 27.1–47.7) in the SP group, 20.6% (14/68, 95% CI 11.7–32.1) in the AQ group and 22.8% (18/79, 95% CI 14.1–33.6) in the CQ + SP group. Early failures were particularly frequent in the SP group (15.2%). Clearance of gametocytes was slower in the SP and CQ + SP groups than in the AQ group. This study suggests that, in Bundi Bugyo, CQ + SP (Uganda's first-line regimen) will need to be replaced by a more efficacious regimen. Across Uganda, the deployment of SP containing combinations may not be a feasible long-term strategy. For Bundi Bugyo, we recommend a combination of artesunate and AQ. Our study also confirms previous findings that resistance is considerably underestimated by 14-day follow-ups. Antimalarial policy decisions should therefore be based on 28-day studies, with PCR adjustment to distinguish re-infections.

Keywords: Plasmodium falciparum; Uganda; amodiaquine; chloroquine; efficacy; malaria; sulfadoxine–pyrimethamine

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2004.01217.x

Affiliations: 1:  Epicentre, Paris, France 2:  Médecins Sans Frontières, Paris, France 3:  Malaria Control Programme, Ministry of Health, Kampala, Uganda 4:  Shoklo Malaria Research Unit, Mae Sot, Thailand

Publication date: April 1, 2004

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