Comparative efficacy of artesunate and sulphadoxine-pyrimethamine combination with artesunate and amodiaquine combination in uncomplicated falciparum malaria in children
Abstract
Background Malaria is still an important cause of mortality
and morbidity in children and adults in tropical countries.
Multidrug resistance againts chloroquine and sulphadox-
ine-pyrimethamine had brought to an introduction of
artemisinin-based combination.
Objective To assess the alternative treatment of uncompli-
cated falciparum malaria in children using artesunate and
sulphadoxine-pyrimethamine combination comparing to
artesunate and amodiaquine combination.
Methods This is a single-blind randomized trial. Sixty-
seven children aged six months to 13 years, were recruited.
Thirty-three children were treated with artesunate 4 mg/
kgbw/day for three days with an additional sulphadoxine-
pyrimethamine (pyrimethamine 1-1.5 mg/kgbw) single
dose on the first day, while 34 children were treated with
artesunate and amodiaquine base 10 mg/kgbw/day for the
first two days, then 5 mg/kgbw/day on the third day. Body
temperature and parasite count were recorded everyday
for at least seven days. The outcomes were fever clearance
time, parasite clearance time, cure rate and side effects. Sta-
tistical analysis was performed using the student t-test.
Results The statistical analysis showed that there were
no difference between these two groups either in fever
clearance time (P>0.05), or in parasite clearance time
(P>0.05). The cure rate was 100% in both groups. Vomit-
ing was found in one patient treated with artesunate and
amodiaquine combination.
Conclusion The combination of artesunate and sulpha-
doxine-pyrimethamine and combination of artesunate
and amodiaquine were found to be equally effective in the
treatment of uncomplicated falciparum malaria in children
References
malaria, 2006.
2. Departemen Kesehatan Republik Indonesia, Direktorat
Jenderal Pemberantasan Penyakit Menular dan Penyehatan
Lingkungan. Pedoman penatalaksanaan kasus malaria di
Indonesia, Jakarta, 2006.
3. Filler S, Causer LM, Newman RD, Barber AM, Roberts JM,.
MacArthur J, et al. Malaria surveillance-United States, 2001.
MMWR Surveill Summ 2003;52: 1.
4. Rampengan TH. Malaria pada anak. In: Harijanto PN, edi-
tor. Malaria epidemiologi, patogenesis, manifestasi klinis dan
penanganan. Jakarta: EGC; 2000. p. 249-77.
5. Krause PJ. Malaria (Plasmodium). In : Behrman RE, Klegman
RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 17Th
ed. Philadelphia: WB Saunders Co; 2004. p. 1139-43.
6. Kundu R, Ganguly N, Ghosh TK, Choudhury P, Shah R.
Diagnosis and treatment malaria in child. Indian Pediatric
2005;42: 1101-14.
7. Stauffer W, Fischer PR. Diagnosis and treatment of malaria
in children. Clin Infect Dis 2003;3 7:1340-8.
8. Leder K, Weller PF. Epidemiology, pathogenesis, clinical
features, and diagnosis of malaria. Available from url: http://
www. uptodate.com.
9. Attaran A, Barnes KI, Curtis C, d'Alessandro U,Fanello
CI,Galinski MR, et al. WHO, the global fund, and medical
malpractice in malaria treatment. Lancet 2004;363;23 7-
40.
10. Sungkar S. Pribadi W. Resistensi Plasmodium falsiparum
terhadap obat-obat malaria. Maj Ked Indones. 1992;42: 155-
61.
11. Rampengan J, Rampengan TH. Malaria tropika pada anak
yang resisten II terhadap fansidar. Maj Ked Indones 1988;38
Suppl 2:77-80.
12. Rampengan J, Mulyanto A, Kaunang ED, Rampengan TH.
Malaria tropika pada anak yang resisten II terhadap kina
sulfat. Maj Farmakologi dan Terapi Indonesia 2000; 13:4-7.
13. Von Seidlein L, Bojang K, Jones P. A randomized controlled
trial of artemether benflumetol, a new antimalarial and py-
rimetamine sulphadoxine in the treatment of uncomplicated
falciparum malaria in Africa children. Am J Trop Med Hyg
1998;58:638-44.
14. Von Seidlein L, Milligan P, Pinder M, Bojang K, Anyalebechi
C, Gosling R, et al. Efficacy of artesunate plus pyrimethamine-
sulphadoxine for uncomplicated malaria in Gambian
children: double-blind, community-randomised, placebo
controlled trial. Lancet 2000;355:352-57.
15. Silitonga K, Rampengan TH. Comparative efficacy of combi-
nation fansidar-sulphat quinine and fansidar- HCl tetracycline
in falciparum malaria in children above 7 years old. Pediatr
Indones 1991 ;31:111-6.
16. Sowunmi A, Falade AG, Adedeji AA, Ayede AI, VN
Ndikum, CO Suwunmi, et al. Comparative Plasmodium
falciparum kinetics during treatment with amodiaquine and
chloroquine in children. Clin Drug Invest 2001;21 Suppl
5:371-81.
17. Magi G, Rampengan TH. The efficacy of sulphate quinine
compared to fansidar in treating falciparum malaria in children
6 months- 7 years old. Pediatr Indones 1991;31:104-10.
18. Maroushek SR, Aguilar E. Asymptomatic malaria in Liberian
Children. Pediatr Res 2002;51:193.
19. Chongsuphajaisiddhi T. Malaria in paediatric practice. In:
Wernsdorfer WH, McGregor I. editors. Malaria principles
and practice of malariology. New York: Churchill Livingstone;
1988. p. 889-901.
20. Van den Broek IV, Maung UA, Peters A, Liem L, Kamal
M, Rahman M, et al. Efficacy of chloroquine+sulfadoxine-
pyrimetamine, mefloquine + artesunate and artemether +
lumefantrine combination therapies to treat Plasmodium
falciparum malaria in the Chittagong Hill Tracts, Bangladesh.
Trans R Soc Trap Med Hyg 2005;99:727-35.
21. Van den Broek I, Amsalu R, Balasegaram M, Hepple P, Alemu
E, Hussein EB, et al. Efficacy of two artemisinin combination
therapies for uncomplicated falciparum malaria in children
under 5 years, Malakal, Upper Nile Sudan. Malaria Journal
2005;4:14.
22. Karam KA, Abuaku B, Duah N, Quashie N. Comparative
efficacy of antimalarialdrugs including ACTs in the treatment
of uncomplicated malaria among children under 5 years in
Ghana. Acta Tropica 2005;95: 194-203.
23. Tambajong F. Perbandingan efikasi kombinasi klorokuin
dan sulfadoksin-pirimetamin dengan artemeter dan sulfa-
doksin-pirimetamin pada pengobatan malaria tropika tanpa
komplikasi pada anak. (Thesis). Manado: Universitas Sam
Ratulangi; 2002.
24. Dorsey G, Njama D, Kamya MR, Cattamanchi A, Kyabayinze
D, Gasasira A, et al. Sulfadoxine/pyrimethamine alone or
with amodiaquine or artesunate for treatment of uncom-
plicated malaria: a longitudinal randomised trial. Lancet
2002;360:2031-38.
25. World Health Organization. Assesment of therapic efficacy
of antimalarial drugs for uncomplicated falciparum malaria.
2001.
26. Guthmann JP, Ampuero J, Fortes F, van Overmeir C, Gabou-
laud V, Tobback S, et al. Antimalarial efficacy of chloroquine,
amodiquine, sulphadoxine-pyrimetamine, and the combina-
tions of amodiaquine + artesunate and sulfadoxine-pyrimet-
amine + artesunate in Huambo and Bie provinces, central
Angola. Trans R Soc Trop Med Hyg 2005;99:485-92.
27. Tjitra E. Obat anti-malaria. In: Harijanto PN editor. Malaria:
epidemiologi, patogenesis, manifestasi klinik dan penan-
ganan. Cetakan I. Jakarta: Penerbit Buku Kedokteran EGC;
2000. p. 194-216.
28. Shapiro TA, Goldberg DE. Chemotherapy of protozoal
infections: malaria. In: Brunton LL, Lazo JS, Parker KL edi-
tors. Goodman and Gilman's the pharmacological basis of
therapeutics. United States of America McGraw-Hill Co;
2006. p. 1021-47.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2016-09-10
Published 2008-08-31
