Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
<p>Abstract</p> <p>Background</p> <p>The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant <it>Plasmodiu...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2010-02-01
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| Series: | Malaria Journal |
| Online Access: | http://www.malariajournal.com/content/9/1/56 |
| _version_ | 1819029041617829888 |
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| author | Thalabard Jean-Christophe Soula Georges Gwét Henri Foumane Vincent Tahar Rachida Whegang Solange Basco Leonardo K |
| author_facet | Thalabard Jean-Christophe Soula Georges Gwét Henri Foumane Vincent Tahar Rachida Whegang Solange Basco Leonardo K |
| author_sort | Thalabard Jean-Christophe |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant <it>Plasmodium falciparum</it>. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging.</p> <p>Methods</p> <p>Studies were conducted in Cameroonian children with acute uncomplicated <it>P. falciparum </it>malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28) were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis.</p> <p>Findings</p> <p>The results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ) is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]). AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP.</p> <p>Conclusion</p> <p>Although AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.</p> |
| first_indexed | 2024-12-21T06:07:57Z |
| format | Article |
| id | doaj.art-4e2f6641fc5f4fa3ac9b2182a34d810a |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-21T06:07:57Z |
| publishDate | 2010-02-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj.art-4e2f6641fc5f4fa3ac9b2182a34d810a2022-12-21T19:13:36ZengBMCMalaria Journal1475-28752010-02-01915610.1186/1475-2875-9-56Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in CameroonThalabard Jean-ChristopheSoula GeorgesGwét HenriFoumane VincentTahar RachidaWhegang SolangeBasco Leonardo K<p>Abstract</p> <p>Background</p> <p>The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant <it>Plasmodium falciparum</it>. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging.</p> <p>Methods</p> <p>Studies were conducted in Cameroonian children with acute uncomplicated <it>P. falciparum </it>malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28) were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis.</p> <p>Findings</p> <p>The results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ) is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]). AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP.</p> <p>Conclusion</p> <p>Although AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.</p>http://www.malariajournal.com/content/9/1/56 |
| spellingShingle | Thalabard Jean-Christophe Soula Georges Gwét Henri Foumane Vincent Tahar Rachida Whegang Solange Basco Leonardo K Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon Malaria Journal |
| title | Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon |
| title_full | Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon |
| title_fullStr | Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon |
| title_full_unstemmed | Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon |
| title_short | Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon |
| title_sort | efficacy of non artemisinin and artemisinin based combination therapies for uncomplicated falciparum malaria in cameroon |
| url | http://www.malariajournal.com/content/9/1/56 |
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