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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
High risk of severe anaemia after chlorproguanil-dapsone+artesunate antimalarial treatment in patients with G6PD (A-) deficiency
PLoS ONE, Volume 3, No. 12, Article e4031, Year 2008
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Description
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common inherited human enzyme defect. This deficiency provides some protection from clinical malaria, but it can also cause haemolysis after administration of drugs with oxidant properties. Methods: The safety of chlorproguanil-dapsone+artesunate (CD+A) and amodiaquine+sulphadoxine-pyrimethamine (AQ+SP) for the treatment of uncomplicated P. falciparum malaria was evaluated according to G6PD deficiency in a secondary analysis of an open-label, randomized clinical trial [1]. 702 children, treated with CD+A or AQ+SP and followed for 28 days after treatment were genotyped for G6PD A- deficiency. Findings: In the first 4 days following CD+A treatment, mean haematocrit declined on average 1.94% (95% CI 1.54 to 2.33) and 1.05% per day (95% CI 0.95 to 1.15) respectively in patients with G6PD deficiency and normal patients; a mean reduction of 1.3% per day was observed among patients who received AQ+SP regardless of G6PD status (95% CI 1.25 to 1.45). Patients with G6PD deficiency recipients of CD+A had significantly lower haematocrit than the other groups until day 7 (p = 0.04). In total, 10 patients had severe post-treatment haemolysis requiring blood transfusion. Patients with G6PD deficiency showed a higher risk of severe anaemia following treatment with CD+A (RR = 10.2; 95% CI 1.8 to 59.3) or AQ+SP (RR = 5.6; 95% CI 1.0 to 32.7). Conclusions: CD+A showed a poor safety profile in individuals with G6PD deficiency most likely as a result of dapsone induced haemolysis. Screening for G6PD deficiency before drug administration of potentially pro-oxidants drugs, like dapsone-containing combinations, although seldom available, is necessary. © 2008 Fanello et al.
Authors & Co-Authors
Fanello, Caterina I.
United Kingdom, Oxford
Nuffield Department of Medicine
Thailand, Nakhon Pathom
Mahidol University
Karema, Corine Kakizi
Rwanda, Kigali
National Malaria Control Program
Avellino, Pamela
Italy, Rome
Sapienza Università Di Roma
Bancone, Germana
Italy, Rome
Sapienza Università Di Roma
Uwimana, Aline
Rwanda, Kigali
National Malaria Control Program
Lee, Sue J.
United Kingdom, Oxford
Nuffield Department of Medicine
Thailand, Nakhon Pathom
Mahidol University
D'Alessandro, Umberto
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Modiano, David
Italy, Rome
Sapienza Università Di Roma
Statistics
Citations: 68
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0004031
e-ISSN:
19326203
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial