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Efficacy of chloroquine, amodiaquine, sulphadoxine–pyrimethamine and combination therapy with artesunate in Mozambican children with non-complicated malaria

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This paper reports a two-phase study in Manhiça district, Mozambique: first we assessed the clinical efficacy and parasitological response of Plasmodium falciparum to chloroquine (CQ), sulphadoxine–pyrimethamine (SP) and amodiaquine (AQ), then we tested the safety and efficacy in the treatment of uncomplicated malaria, of three combinations: AQ + SP, artesunate (AR) + SP and AQ + AR. Based on the WHO (1996, WHO/MAL/96.1077) in vivo protocol, we conducted two open, randomized, clinical trials. Children aged 6–59 months with axillary body temperature ≥37.5 °C and non-complicated malaria were randomly allocated to treatment groups and followed up for 21 days (first and second trial) and 28 days (first trial). The therapeutic efficacy of AQ (91.6%) was better than that of SP (82.7%) and CQ (47.1%). After 14 days, 69% of the strains were parasitologically resistant to CQ, 21.4% to SP and 26% to AQ. Co-administration of AQ + SP, AR + SP and AQ + AR was safe and had 100% clinical efficacy at 14-day follow-up. The combination therapies affected rapid fever clearance time and reduced the incidence of gametocytaemia during follow-up.
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Keywords: Plasmodium falciparum; antimalarials; combination therapy; drug resistance; first-line treatment; national policy

Document Type: Research Article

Affiliations: 1:  National Malaria Control Programme, Direcção Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique 2:  Danish Bilharziasis Laboratories, Copenhagen, Denmark 3:  Center of Medical Parasitology, Department of International Health, University of Copenhagen, Copenhagen, Denmark

Publication date: February 1, 2004

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