Efficacy of sulfadoxine-pyrimethamine in Tanzania after two years as first-line drug for uncomplicated malaria: assessment protocol and implication for treatment policy strategies

Détails

ID Serval
serval:BIB_1E681176D8E1
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Efficacy of sulfadoxine-pyrimethamine in Tanzania after two years as first-line drug for uncomplicated malaria: assessment protocol and implication for treatment policy strategies
Périodique
Malaria Journal
Auteur(s)
Mugittu  K., Abdulla  S., Falk  N., Masanja  H., Felger  I., Mshinda  H., Beck  H. P., Genton  B.
ISSN
1475-2875 (Electronic)
Statut éditorial
Publié
Date de publication
2005
Volume
4
Numéro
1
Pages
55
Notes
Journal Article
Research Support, Non-U.S. Gov't
Résumé
BACKGROUND: Systematic surveillance for resistant malaria shows high level of resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) across eastern and southern parts of Africa. This study assessed in vivo SP efficacy after two years of use as an interim first-line drug in Tanzania, and determined the rates of treatment failures obtained after 14 and 28 days of follow-up. METHODS: The study was conducted in the Ipinda, Mlimba and Mkuranga health facilities in Tanzania. Children aged 6-59 months presenting with raised temperature associated exclusively with P. falciparum (1,000-100,000 parasites per microl) were treated with standard dose of SP. Treatment responses were classified according to the World Health Organization (WHO) definition as Adequate Clinical and Parasitological Response (ACPR), Early Treatment Failure (ETF), Late Clinical Failure (LCF) and Late Parasitological Failure (LPF) on day 14 and day 28. RESULTS: Overall 196 (85.2%) of 230 patients had ACPR on day 14 but only 116 (50.9%) on day 28 (57.7% after excluding new infections by parasite genotyping). Altogether 21 (9.1%) and 13 (5.7%) of the 230 patients assessed up to day 14 and 39 (17.1%) and 55 (24.1%) of the 228 followed up to day 28 had clinical and parasitological failure, respectively. CONCLUSION: These findings indicate that SP has low therapeutic value in Tanzania. The recommendation of changing first line treatment to artemether + lumefantrine combination therapy from early next year is, therefore, highly justified. These findings further stress that, for long half-life drugs such as SP, establishment of cut-off points for policy change in high transmission areas should consider both clinical and parasitological responses beyond day 14.
Mots-clé
Animals Antigens, Protozoan/genetics Antimalarials/*therapeutic use Body Temperature Child, Preschool Drug Combinations Drug Evaluation/methods Drug Therapy, Combination Genotype Health Policy/*trends Hemoglobins/analysis Humans Infant Malaria, Falciparum/*drug therapy Parasitemia/blood Plasmodium falciparum/classification/genetics Protozoan Proteins/genetics Pyrimethamine/*therapeutic use Sulfadoxine/*therapeutic use Tanzania Treatment Outcome
Pubmed
Web of science
Open Access
Oui
Création de la notice
28/01/2008 12:48
Dernière modification de la notice
20/08/2019 13:54
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