Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy.
In areas where multidrug-resistant Plasmodium falciparum (MDR-Pf) is prevalent, only quinine is known to be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervised quinine (30 mg/kg daily) cures two-thirds of P. falciparum-infected women in the 2nd and 3rd trime...
| 主要な著者: | , , , , , , , , |
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| フォーマット: | Journal article |
| 言語: | English |
| 出版事項: |
2001
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| _version_ | 1826303722821517312 |
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| author | Mcgready, R Cho, T Samuel Villegas, L Brockman, A van Vugt, M Looareesuwan, S White, N Nosten, F |
| author_facet | Mcgready, R Cho, T Samuel Villegas, L Brockman, A van Vugt, M Looareesuwan, S White, N Nosten, F |
| author_sort | Mcgready, R |
| collection | OXFORD |
| description | In areas where multidrug-resistant Plasmodium falciparum (MDR-Pf) is prevalent, only quinine is known to be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervised quinine (30 mg/kg daily) cures two-thirds of P. falciparum-infected women in the 2nd and 3rd trimesters of pregnancy. Artesunate is effective against MDR-Pf and the limited data on its use in pregnancy suggest it is safe. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) in combination with clindamycin (5 mg/kg every 8 h) for 7 days (QC7) versus artesunate 2 mg/kg per day for 7 days (A7) was conducted in 1997-2000 in 129 Karen women with acute uncomplicated falciparum malaria in the 2nd or 3rd trimesters of pregnancy. There was no difference in the day-42 cure rates between the QC7 (n = 65) and A7 (n = 64) regimens with an efficacy of 100% in both, confirmed by parasite genotyping. The A7 regimen was also associated with less gametocyte carriage; the average person-gametocyte-weeks for A7 was 3 (95% CI 0-19) and for QC7 was 39 (95% CI 21-66) per 1000 person-weeks, respectively (P < 0.01). There was no difference in gastrointestinal symptoms between the groups but there was significantly more tinnitus in the QC7 group compared to the A7 group (44.9% vs 8.9%; RR 5.1; 95% CI 1.9-13.5; P < 0.001). The favourable results with quinine-clindamycin mean that there is a useful back-up treatment for women with falciparum malaria who experience quinine and artesunate failures in pregnancy. Adherence to the 7-day regimen and cost (US$18.50 per treatment) are likely to be the main obstacles to this regimen. |
| first_indexed | 2024-03-07T06:07:02Z |
| format | Journal article |
| id | oxford-uuid:ee32b78e-c8e1-4b54-88dc-9adb7ca62013 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T06:07:02Z |
| publishDate | 2001 |
| record_format | dspace |
| spelling | oxford-uuid:ee32b78e-c8e1-4b54-88dc-9adb7ca620132022-03-27T11:30:54ZRandomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:ee32b78e-c8e1-4b54-88dc-9adb7ca62013EnglishSymplectic Elements at Oxford2001Mcgready, RCho, TSamuelVillegas, LBrockman, Avan Vugt, MLooareesuwan, SWhite, NNosten, FIn areas where multidrug-resistant Plasmodium falciparum (MDR-Pf) is prevalent, only quinine is known to be safe and effective in pregnant women. On the western border of Thailand, 7 days of supervised quinine (30 mg/kg daily) cures two-thirds of P. falciparum-infected women in the 2nd and 3rd trimesters of pregnancy. Artesunate is effective against MDR-Pf and the limited data on its use in pregnancy suggest it is safe. An open randomized comparison of supervised quinine (10 mg salt/kg every 8 h) in combination with clindamycin (5 mg/kg every 8 h) for 7 days (QC7) versus artesunate 2 mg/kg per day for 7 days (A7) was conducted in 1997-2000 in 129 Karen women with acute uncomplicated falciparum malaria in the 2nd or 3rd trimesters of pregnancy. There was no difference in the day-42 cure rates between the QC7 (n = 65) and A7 (n = 64) regimens with an efficacy of 100% in both, confirmed by parasite genotyping. The A7 regimen was also associated with less gametocyte carriage; the average person-gametocyte-weeks for A7 was 3 (95% CI 0-19) and for QC7 was 39 (95% CI 21-66) per 1000 person-weeks, respectively (P < 0.01). There was no difference in gastrointestinal symptoms between the groups but there was significantly more tinnitus in the QC7 group compared to the A7 group (44.9% vs 8.9%; RR 5.1; 95% CI 1.9-13.5; P < 0.001). The favourable results with quinine-clindamycin mean that there is a useful back-up treatment for women with falciparum malaria who experience quinine and artesunate failures in pregnancy. Adherence to the 7-day regimen and cost (US$18.50 per treatment) are likely to be the main obstacles to this regimen. |
| spellingShingle | Mcgready, R Cho, T Samuel Villegas, L Brockman, A van Vugt, M Looareesuwan, S White, N Nosten, F Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. |
| title | Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. |
| title_full | Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. |
| title_fullStr | Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. |
| title_full_unstemmed | Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. |
| title_short | Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. |
| title_sort | randomized comparison of quinine clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy |
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