Journal
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE
Volume 99, Issue 10, Pages 727-735Publisher
OXFORD UNIV PRESS
DOI: 10.1016/j.trstmh.2005.02.007
Keywords
malaria; Plasmodium falciparum; chloroquine; sulfadoxine-pyrimethamine; mefloquine; artesunate; lumefantrine; artemether; Bangladesh
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Bangladesh faces growing levels of Plosmodium falciparum resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP). Alternative antimalarial therapies, particularly combination regimens, need to be considered. Therefore, the efficacy of three antimalarial combination therapies was assessed in Chittagong Hilt Tracts. A total of 364 P falciparum patients were recruited and randomly assigned to either CQ+SP, mefloquine+artesunate (MQ+AS) or lumefantrine+artemether (Coartem (c)). Results showed that CQ+SP therapy was less effective than the two artemisinin-based combination therapies. The day 42 PCR-corrected efficacy rate was 62.4% for CQ+SP, 100% for MQ+AS and 97.1% for Coartem. Failures occurred at a shorter interval after CQ+SP treatment than after Coartem. The artemisinin-based therapies effectively prevented development of gametocytes, whereas CQ+SP did not. All three therapies were well tolerated, although reports of mild complaints during treatment appeared higher with MQ+AS. We conclude that CQ+SP is not a viable option for replacing CQ monotherapy as first-line P falciparum treatment in this area of Bangladesh. A change to artemisinin-based combination therapy is recommended. Both Coartem and MQ+AS appear to be good options, effective in curing P falciparum malaria and in preventing recrudescences following treatment. (c) 2005 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
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