A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan
<p>Abstract</p> <p>Background</p> <p>A combination of artesunate (AS) plus sulphadoxine/pyrimethamine (SP) as first-line and artemether-lumefantrine (AL) as second-line treatment are currently recommended against uncomplicated <it>P. falciparum </it>infectio...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2007-07-01
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| Series: | Malaria Journal |
| Online Access: | http://www.malariajournal.com/content/6/1/92 |
| _version_ | 1819029365046902784 |
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| author | Mansour Fathi A Mukhtar Izdihar El-zaki Salah-Eldin G Gadalla Nahla B Mukhtar Ebtihal A Babiker Ahmed El-Sayed Badria B |
| author_facet | Mansour Fathi A Mukhtar Izdihar El-zaki Salah-Eldin G Gadalla Nahla B Mukhtar Ebtihal A Babiker Ahmed El-Sayed Badria B |
| author_sort | Mansour Fathi A |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>A combination of artesunate (AS) plus sulphadoxine/pyrimethamine (SP) as first-line and artemether-lumefantrine (AL) as second-line treatment are currently recommended against uncomplicated <it>P. falciparum </it>infection in Sudan. However, there is limited information on the efficacy of ACTs in the country and only one report of PCR-corrected results for AS/SP only.</p> <p>Methods</p> <p>The WHO protocol for the assessment of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria was employed. Artesunate plus sulphadoxine/pyrimethamine (AS/SP) was compared to artemether-lumefantrine (AL) in a 28-day follow up. Samples that were classified as early treatment failure (ETF), late treatment failure (LCF) or late parasitological failure (LPF) were genotyped for <it>msp-1 </it>and <it>msp</it>-<it>2 </it>genes to differentiate recrudescence from reinfection.</p> <p>Results</p> <p>A total of 178 patients were screened and 160 met the enrolment criteria and were recruited to the study of which 157 (98.1%) completed the follow up and had an analysed treatment outcome. On the AS/SP arm, three (0.038%) patients were lost during the follow-up, two on day 1 and one on day 7, and 77 (96.3) completed the study, while all 80 (100%) patients completed the follow up in the AL arm. In the per protocol analysis for AS/SP the treatment outcome for patients who completed the follow-up were as follows: adequate clinical and parasitological response (ACPR); 84.4% ETF; 1.3%, LCF; 3.9%, (LPF); 10.4%. For the AL arm the out come was as follows, ACPR; 90%, ETF; 0%, LCF; 6.3% and LPF; 3.8%. However, when PCR-corrected, 6.5% (5/77) of patients treated with AS/SP maintained parasites from their primary infection, while (7/80) in the AL group maintained their initial parasite genotype. Therefore, PCR-corrected efficacy was 93.5% in the AS/SP treated group and for AL it was 91.3%.</p> <p>Conclusion</p> <p>Both AS/SP and AL are highly effective for the treatment of uncomplicated falciparum malaria in eastern Sudan. However, AS/SP appears to have a slightly higher efficacy than AL, this may be due to patient compliance with the repeated dose rather than drug efficacy.</p> |
| first_indexed | 2024-12-21T06:13:06Z |
| format | Article |
| id | doaj.art-97d2a1ddbe75483e92215ce8fda7d80a |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-21T06:13:06Z |
| publishDate | 2007-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-97d2a1ddbe75483e92215ce8fda7d80a2022-12-21T19:13:29ZengBMCMalaria Journal1475-28752007-07-01619210.1186/1475-2875-6-92A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern SudanMansour Fathi AMukhtar IzdiharEl-zaki Salah-Eldin GGadalla Nahla BMukhtar Ebtihal ABabiker AhmedEl-Sayed Badria B<p>Abstract</p> <p>Background</p> <p>A combination of artesunate (AS) plus sulphadoxine/pyrimethamine (SP) as first-line and artemether-lumefantrine (AL) as second-line treatment are currently recommended against uncomplicated <it>P. falciparum </it>infection in Sudan. However, there is limited information on the efficacy of ACTs in the country and only one report of PCR-corrected results for AS/SP only.</p> <p>Methods</p> <p>The WHO protocol for the assessment of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria was employed. Artesunate plus sulphadoxine/pyrimethamine (AS/SP) was compared to artemether-lumefantrine (AL) in a 28-day follow up. Samples that were classified as early treatment failure (ETF), late treatment failure (LCF) or late parasitological failure (LPF) were genotyped for <it>msp-1 </it>and <it>msp</it>-<it>2 </it>genes to differentiate recrudescence from reinfection.</p> <p>Results</p> <p>A total of 178 patients were screened and 160 met the enrolment criteria and were recruited to the study of which 157 (98.1%) completed the follow up and had an analysed treatment outcome. On the AS/SP arm, three (0.038%) patients were lost during the follow-up, two on day 1 and one on day 7, and 77 (96.3) completed the study, while all 80 (100%) patients completed the follow up in the AL arm. In the per protocol analysis for AS/SP the treatment outcome for patients who completed the follow-up were as follows: adequate clinical and parasitological response (ACPR); 84.4% ETF; 1.3%, LCF; 3.9%, (LPF); 10.4%. For the AL arm the out come was as follows, ACPR; 90%, ETF; 0%, LCF; 6.3% and LPF; 3.8%. However, when PCR-corrected, 6.5% (5/77) of patients treated with AS/SP maintained parasites from their primary infection, while (7/80) in the AL group maintained their initial parasite genotype. Therefore, PCR-corrected efficacy was 93.5% in the AS/SP treated group and for AL it was 91.3%.</p> <p>Conclusion</p> <p>Both AS/SP and AL are highly effective for the treatment of uncomplicated falciparum malaria in eastern Sudan. However, AS/SP appears to have a slightly higher efficacy than AL, this may be due to patient compliance with the repeated dose rather than drug efficacy.</p>http://www.malariajournal.com/content/6/1/92 |
| spellingShingle | Mansour Fathi A Mukhtar Izdihar El-zaki Salah-Eldin G Gadalla Nahla B Mukhtar Ebtihal A Babiker Ahmed El-Sayed Badria B A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan Malaria Journal |
| title | A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan |
| title_full | A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan |
| title_fullStr | A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan |
| title_full_unstemmed | A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan |
| title_short | A comparative study on the efficacy of artesunate plus sulphadoxine/pyrimethamine versus artemether-lumefantrine in eastern Sudan |
| title_sort | comparative study on the efficacy of artesunate plus sulphadoxine pyrimethamine versus artemether lumefantrine in eastern sudan |
| url | http://www.malariajournal.com/content/6/1/92 |
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