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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Sulphadoxine/pyrimethamine versus amodiaquine for treating uncomplicated childhood malaria in Gabon: A randomized trial to guide national policy
Malaria Journal, Volume 7, Article 31, Year 2008
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Description
Background. In Gabon, following the adoption of amodiaquine/artesunate combination (AQ/AS) as first-line treatment of malaria and of sulphadoxine/pyrimethamine (SP) for preventive intermittent treatment of pregnant women, a clinical trial of SP versus AQ was conducted in a sub-urban area. This is the first study carried out in Gabon following the WHO guidelines. Methods. A random comparison of the efficacy of AQ (10 mg/kg/day × 3 d) and a single dose of SP (25 mg/kg of sulphadoxine/1.25 mg/kg of pyrimethamine) was performed in children under five years of age, with uncomplicated falciparum malaria, using the 28-day WHO therapeutic efficacy test. In addition, molecular genotyping was performed to distinguish recrudescence from reinfection and to determine the frequency of the dhps K540E mutation, as a molecular marker to predict SP-treatment failure. Results. The day-28 PCR-adjusted treatment failures for SP and AQ were 11.6% (8/69; 95% IC: 5.5-22.1) and 28.2% (20/71; 95% CI: 17.7-38.7), respectively This indicated that SP was significantly superior to AQ (P = 0.019) in the treatment of uncomplicated childhood malaria and for preventing recurrent infections. Both treatments were safe and well-tolerated, with no serious adverse reactions recorded. The dhps K540E mutation was not found among the 76 parasite isolates tested. Conclusion. The level of AQ-resistance observed in the present study may compromise efficacy and duration of use of the AQ/AS combination, the new first-line malaria treatment. Gabonese policy-makers need to plan country-wide and close surveillance of AQ/AS efficacy to determine whether, and for how long, these new recommendations for the treatment of uncomplicated malaria remain valid. © 2008 Nsimba et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Nsimba, Basile
Congo, Bunia
Ministry of Health
Guiyedi, Vincent
Gabon
Faculty of Medicine and Health Sciences
Mabika Mamfoumbi, M.
Gabon
Faculty of Medicine and Health Sciences
Mourou-Mbina, Jean Romain
Gabon
Faculty of Medicine and Health Sciences
Ngoungou, Edgard Brice
Gabon
Faculty of Medicine and Health Sciences
Bouyou-Akotet, Marielle Karine
Gabon
Faculty of Medicine and Health Sciences
Loembet, Romaric
Gabon
Faculty of Medicine and Health Sciences
Durand, Rémy
France, Bobigny
Hopital Avicenne
France, Villetaneuse
University Sorbonne Paris Nord
Le Bras, Jacques L.
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
France, Descartes
University Paris
Kombila, Maryvonne Y.
Gabon
Faculty of Medicine and Health Sciences
Statistics
Citations: 33
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1186/1475-2875-7-31
e-ISSN:
14752875
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Locations
Gabon
Participants Gender
Female