Comparative efficacy of halofantrine, chloroquine and sulfadoxine-pyrimethamine for treatment of acute uncomplicated falciparum malaria in Nigerian children

Falade, CO; Salako, L.A.; Sowunmi, A.; Oduola, A. M. J.; Larcier, Patrick

doi:10.1016/s0035-9203(97)90397-7

Cited by 57 publications

(34 citation statements)

References 13 publications

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“…This progressive decline in the sensitivity of P. falciparum is most marked with chloroquine and sulfadoxine-pyrimethamine, which until recently were first-line antimalarial drugs in Nigeria. Failure rates as high as 50% to 95% have been reported for chloroquine in some parts of the country (Sowunmi & Salako 1992;Falade et al 1997;Federal Ministry of Health 2004). The World Health Organization (2001) has recommended artemisinin-based combination therapy (ACT) for the treatment of malaria in countries experiencing resistance to antimalarial drug monotherapy (World Health Organization 2001).…”

Section: Introductionmentioning

confidence: 99%

High efficacy of two artemisinin‐based combinations (artemether–lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria

Falade

Ogundele

Yusuf

et al. 2008

Tropical Med Int Health

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Summaryobjective To test the hypothesis that artesunate plus amodiaquine (ASAQ) is as effective as artemether-lumefantrine (AL) in the treatment of acute uncomplicated malaria in Nigerian children.methods In an open label, randomized controlled clinical trial, children aged 6 months to 10 years were randomized to receive artesunate (4 mg ⁄ kg daily) plus amodiaquine (10 mg ⁄ kg daily) or AL (5-14 kg, one tablet; 15-24 kg, two tablets and 25-34 kg, three tablets twice daily). Both drug regimens were given for 3 days and follow-up was for 28 days.results A total of 132 children (66 in each group) were randomized to receive either ASAQ or AL. Day 28 cure rates in the per protocol (PP) population were 93% for ASAQ and 95% for AL (OR = 0.71, 95% CI = 0.12-3.99, q = 0.66). Using Kaplan-Meier product-limit estimates of failure, the median survival time for ASAQ was 21 days and for AL 28 days (P = 0.294). PCR corrected day 28 cure rate for PP populations were 98.4% for ASAQ and 100% for AL. Both drugs were well-tolerated.conclusion ASAQ is as effective as AL and both combinations were efficacious and safe.

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Section: Introductionmentioning

confidence: 99%

High efficacy of two artemisinin‐based combinations (artemether–lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria

Falade

Ogundele

Yusuf

et al. 2008

Tropical Med Int Health

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“…[1][2][3] Despite the emergence and spread of resistance, chloroquine and pyrimethamine/sulfadoxine remain the first-and second-line treatments for malaria in most African countries. [3][4][5][6] Malaria control efforts need to be designed for the specific environment in which they will be used, taking into account the local epidemiology. Also, the drug-resistant strains of malaria are constantly changing in time and space.…”

Section: Introductionmentioning

confidence: 99%

Surveillance of in Vivo Resistance of Plasmodium Falciparum to Antimalarial Drugs From 1992 to 1999 in Malabo (Equatorial Guinea)

Roche

Guerra-Neira

Raso

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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Abstract. From 1992-1999, we have assessed the therapeutic efficacy of three malaria treatment regimens (chloroquine 25 mg/kg over three days, pyrimethamine/sulfadoxine 1.25/25 mg/kg in one dose, and quinine 25-30 mg/kg daily in three oral doses over a four-, five-, or seven-day period) in 1,189 children under age 10 at Malabo Regional Hospital in Equatorial Guinea. Of those children, 958 were followed up clinically and parasitologically for 14 days. With chloroquine, the failure rate varied from 55% in 1996 to 40% in 1999; the early treatment failure rate increased progressively over the years, from 6% in 1992 to 30% in 1999. With pyrimethamine/sulfadoxine, the failure rate varied from 0% in 1996 to 16% in 1995. The short quinine treatment regimens used in 1992 and 1993 (4 and 5 days, respectively) resulted in significantly higher failure rates (19% and 22%, respectively) than the 7d regimen (3-5.5%). We conclude that: a) failure rates for chloroquine are in the change period (>25%), and urgent action is needed; b) pyrimethamine/ sulfadoxine failure rates are in the alert period (6-15%), and surveillance must be continued; and c) quinine failure rates are in the grace period (<6%), so quinine can be recommended.

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“…This concentration, however, may not be sufficient to protect individuals from infection with resistant parasites. In Nigeria, the efficacy of CQ has continuously declined in recent years, such that the cure rate at day 7 of treatment is 40% (5).…”

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confidence: 99%

Concentrations of Chloroquine and Malaria Parasites in Blood in Nigerian Children

Mockenhaupt

May

Bergqvist

et al. 2000

Antimicrob Agents Chemother

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Consumption of chloroquine (CQ) and subtherapeutic drug levels in blood are considered to be widespread in areas where malaria is endemic. A cross-sectional study was performed with 405 Nigerian children to assess factors associated with the presence of CQ in blood and to examine correlations of drug levels with malaria parasite species and densities. Infections with Plasmodium species and parasite densities were determined by microscopy and PCR assays. Whole-blood CQ concentrations were measured by high-performance liquid chromatography. Plasmodium falciparum, P. malariae, and P. ovale were observed in 80, 16, and 9% of the children, respectively, and CQ was detected in 52% of the children. CQ concentrations were >17 and <100 nmol/liter in 25% of the children, 100 to 499 nmol/liter in 14% of the children, and >500 nmol/liter in 13% of the children. Young age, attendance at health posts, and absence of parasitemia were factors independently associated with CQ in blood. With increasing concentrations of CQ, the prevalence of P. falciparum infection and parasite densities decreased. However, at concentrations corresponding to those usually attained during regular prophylaxis (>500 nmol/liter), 62% of children were still harboring P. falciparum parasites. In contrast, no infection with P. malariae and only one infection with P. ovale were observed in children with CQ concentrations of >100 nmol/liter. These data show the high prevalence of subcurative CQ concentrations in Nigerian children and confirm the considerable degree of CQ resistance in that country. Subtherapeutic drug levels are likely to further promote CQ resistance and may impair the development and maintenance of premunition in areas where malaria is endemic.Chloroquine (CQ) is one of the most widely consumed drugs (7). In 1988, an estimated 190 tons of CQ base were used in Africa alone (28). Self-medication, inadequate dosing, and subtherapeutic levels in blood are frequent and are believed to be predominant factors that contribute to CQ resistance in Plasmodium falciparum (25). However, data on actual CQ levels in residents of areas where malaria is endemic are scarce. The validity of history taking with respect to antimalarial drug usage is commonly low (17). Field methods for the detection of CQ in urine such as the Dill-Glazko test (13) suffer from poor sensitivity and specificity (21) and cannot quantify drug concentrations. Nevertheless, tests for detection of CQ in urine were found to be positive at hospital admission for 32% of patients in Malawi (17) and in 33% of patients in Zimbabwe (23). By applying high-performance liquid chromatography (HPLC), CQ was detected in the blood of up to 80% of schoolchildren in Tanzania, with the drug levels in the majority of children being too low to eliminate even CQ-sensitive parasites (9). The whole-blood CQ concentration required to suppress or eliminate P. falciparum is not well recognized. In adults, concentrations in whole blood of Ն500 nmol/liter are usually attained during prophylactic intake of 31...

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Comparative efficacy of halofantrine, chloroquine and sulfadoxine-pyrimethamine for treatment of acute uncomplicated falciparum malaria in Nigerian children

Cited by 57 publications

References 13 publications

High efficacy of two artemisinin‐based combinations (artemether–lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria

High efficacy of two artemisinin‐based combinations (artemether–lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria

Surveillance of in Vivo Resistance of Plasmodium Falciparum to Antimalarial Drugs From 1992 to 1999 in Malabo (Equatorial Guinea)

Concentrations of Chloroquine and Malaria Parasites in Blood in Nigerian Children

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