Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children: a randomised, multicentre trial

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dc.contributor.author Adjuik, M
dc.contributor.author Agnamey, P
dc.contributor.author Babiker, A
dc.contributor.author Borrmann, S
dc.contributor.author Brasseur, P
dc.contributor.author Cisse, M
dc.contributor.author Cobelens, F
dc.contributor.author Diallo, S
dc.contributor.author Faucher, JF
dc.contributor.author Garner, P
dc.contributor.author Gikunda, S
dc.contributor.author Kremsner, PG
dc.contributor.author Krishna, S
dc.contributor.author Lell, B
dc.contributor.author Loolpapit, M
dc.contributor.author Matsiegui, PB
dc.contributor.author Missinou, MA
dc.contributor.author Mwanza, J
dc.contributor.author Ntoumi, F
dc.contributor.author Olliaro, P
dc.contributor.author Osimbo, P
dc.contributor.author Rezbach, P
dc.contributor.author Some, Eliab
dc.contributor.author Taylor, WR
dc.date.accessioned 2019-12-05T13:59:36Z
dc.date.available 2019-12-05T13:59:36Z
dc.date.issued 2002
dc.identifier.uri http://erepo.usiu.ac.ke/11732/5113
dc.description Journal Article Full text: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08348-4/fulltext en_US
dc.description.abstract Background: Increasing drug resistance limits the choice of efficacious chemotherapy against Plasmodium falciparum malaria in Africa. Amodiaquine still retains efficacy against P falciparum in many African countries. We assessed the safety, treatment efficacy, and effect on gametocyte carriage of adding artesunate to amodiaquine in three randomised trials in Kenya, Sénégal, and Gabon. Methods: We enrolled 941 children (400 in Kenya, 321 in Sénégal, and 220 in Gabon) who were 10 years or older and who had uncomplicated P falciparum malaria. Patients were randomly assigned amodiaquine (10 mg/kg per day for 3 days) plus artesunate (4 mg/kg per day for 3 days) or amodiaquine (as above) and placebo (for 3 days). The primary endpoints were parasitological cure rates at days 14 and 28. Analysis was by intention to treat and by an evaluability method. Findings: Both regimens were well tolerated. Six patients in the amodiaquine-artesunate group and five in the amodiaquine group developed early, drug-induced vomiting, necessitating alternative treatment. By intention-to-treat analysis, the day-14 cure rates for amodiaquine-artesunate versus amodiaquine were: 175/192 (91%) versus 140/188 (74%) in Kenya (D=16.7% [95% CI 9.3-24.1], p<0.0001), 148/160 (93%) versus 147/157 (94%) in Sénégal (-1.1% [-6.7 to 4.5], p=0.7), and 92/94 (98%) versus 86/96 (90%) in Gabon (8.3% [1.5-15.1], p=0.02). The corresponding rates for day 28 were: 123/180 (68%) versus 75/183 (41%) in Kenya (27.3% [17.5-37.2], p<0.0001), 130/159 (82%) versus 123/156 (79%) in Sénégal (2.9% [-5.9 to 11.7], p=0.5), and 80/94 (85%) versus 70/98 (71%) in Gabon (13.7% [2.2-25.2], p=0.02). Similar rates were obtained by evaluability analysis. Interpretation: The combination of artesunate and amodiaquine improved treatment efficacy in Gabon and Kenya, and was equivalent in Sénégal. Amodiaquine-artesunate is a potential combination for use in Africa. Further investigations to assess the potential effect on the evolution of drug resistance, disease transmission, and safety of amodiaquine-artesunate are warranted. en_US
dc.publisher The Lancet en_US
dc.title Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children: a randomised, multicentre trial en_US
dc.type Article en_US

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