Abstract:
:Both northern and southern Sudan are deploying artemisinin-based combinations against uncomplicated Plasmodium falciparum malaria (artesunate+sulfadoxine-pyrimethamine [AS+SP] in the north, artesunate+amodiaquine [AS+AQ] in the south). In 2003, we tested the efficacy of 3 day AS+SP and AS+AQ regimens in vivo in the isolated, seasonally endemic Nuba Mountains region (the first study of AS combinations in southern Sudan). We also analysed pre-treatment blood samples for mutations at the P. falciparum chloroquine transporter (Pfcrt) gene (associated with CQ resistance), and at the dihydrofolate reductase (Dhfr) gene (associated with pyrimethamine resistance). Among 161 randomized children under 5 years, PCR-corrected cure rates after 28 days were 91.2% (52/57, 95% CI 80.7-97.1) for AS+SP and 92.7% (51/55, 95% CI 82.4-98.0) for AS+AQ, with equally rapid parasite and fever clearance. The Pfcrt K76T mutation occurred in 90.0% (144/160) of infections, suggesting CQ would work poorly in this region. Overall, 82.5% (132/160) carried mutations at Dhfr (N51I, C59R or S108N, but not I164L), but triple mutants (more predictive of in vivo SP failure) were rare (3.1%). CQ use should be rapidly discontinued in this region. SP resistance may propagate rapidly, and AS+AQ is likely to be a better long-term option, provided AQ use is limited to the combination.
journal_name
Trans R Soc Trop Med Hygauthors
Hamour S,Melaku Y,Keus K,Wambugu J,Atkin S,Montgomery J,Ford N,Hook C,Checchi Fdoi
10.1016/j.trstmh.2004.10.003subject
Has Abstractpub_date
2005-07-01 00:00:00pages
548-54issue
7eissn
0035-9203issn
1878-3503pii
S0035-9203(05)00067-2journal_volume
99pub_type
临床试验,杂志文章,随机对照试验abstract::Polymerase chain reaction (PCR) is now widely used in malaria research for analysis of field samples. However, little has been reported regarding loss of sensitivity due to field methodology. Therefore, studies were carried out in relation to blood sampling (anticoagulants, culture medium, filter paper), storage (temp...
journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
pub_type: 杂志文章,多中心研究
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
pub_type: 杂志文章
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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pub_type: 杂志文章,评审
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更新日期:2015-04-01 00:00:00