Comparative efficacy of chloroquine and pyrimethamine-sulfadoxine versus artemether and pyrimethamine-sulfadoxine in the treatment of uncomplicated falciparum malaria in children
Keywords:
chloroquine, pyrimethamine-sulfadoxine, artemether, fever clearance time, parasite clearance time, falciparum malaria
Abstract
Background Large amount of data show that chloroquine andpyrimethamine-sulfadoxine (PS) as standard drugs for falciparum
malaria cause resistance; for that reason new drugs or combina-
tion drugs are urgently needed. Artemether is one of the new
drugs. It has been studied extensively in China and Southeast
Asia during the past 10 years. The effectiveness of this drug in
clearing parasites has been thoroughly documented.
Objective The objective of this study was to investigate the
efficacy of the combination of chloroquine and PS compared to
artemether and PS in the treatment of uncomplicated falciparum
malaria.
Methods We did a single-blind randomized study on 60 children
with uncomplicated falciparum malaria. Thirty children were
treated with chloroquine (10 mg/kg for 2 days, then 5 mg/kg in
the 3 rd day) and PS (pyrimethamine 1-1.5 mg/kg single dose on
the 1 st day) and the other 30 children were treated with artemether
(4 mg/kg/day for 3 days) and PS. All patients were admitted to
hospital for at least 7 days.
Results Fever clearance time was significantly shorter in the group
that received artemether and PS compared to that in the chloro-
quine-and-PS group (42 hours vs. 75 hours 50 minutes, p<0.0001).
Parasite clearance time was significantly different between the
group that received artemether and PS and the chloroquine-and-
PS group (2.5 days vs. 3.1 days, p=0.04). The cure rate in the
chloroquine-and-PS group was 28/30 and that of the artemether-
and-PS group was 30/30. Nausea and vomiting were found in 1
patient treated with chloroquine and PS.
Conclusion The combined treatment of artemether and PS was
well tolerated. No adverse reactions attributable to the treatment
were noted
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laria in Africa children. Am J Trop Med Hyg
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Penyehatan Lingkungan Pemukiman. Buku saku
penatalaksanaan kasus malaria. Jakarta: 2000.
2. Rampengan TH, Rampengan J. Chloroquine resistant
falciparum malaria in children. Pediatr Indones
1989;29:13-9.
3. Rampengan J, Rampengan TH. Malaria tropika pada
anak yang resisten II terhadap fansidar. MKI
1988;38:77-80.
4. Wilairatana P, Krudsood S, Treeprasertsuk S,
Chalermrut K, Looareesuwan S. The future outlook
of antimalarial drugs and recent work on the treatment
of malaria. Arch of Med Research 2002;33:416-21
5. Budijanto SK. Artemisin: senyawa baru antimalaria.
JDKI 1994;2:39-41.
6. WHO. Assesment of therapic efficacy of antimalarial
drugs for uncomplicated falciparum malaria. Draft
March 2001.
7. Looareesuwan S, Viravan C, Vabijanonta S, Wilairatana.
Randomised trial of artsunate and mefloquine alone and
in sequence for acute uncomplicated falciparum ma-
laria. Lancet 1992;339:821-4.
8. Seidlein LV, Miligan P, Pinder M, Bojang K, Anyalebechi
C, Gosling R et al. Efficacy of artesunate plus py-
rimethamine-sulphadoxine for uncomplicated malaria in
Gambian children: a double-blind, randomized, con-
trolled trial. Lancet 2000;355:352-7.
9. Vries PJ, Bich NN, Thien HV, Hung LN, Anh TK,
Kager PA, et al. Combinations of artemisin and quinine
for complicated falciparum malaria: efficacy and
pharmacodynamics. Antimicrob Agents Chemother
2000;44:1302-8.
10. Tjitra E, Pribadi W, Raharjo K,Budiono W, Arbani PR,
Naibaho et al. Treatment of uncomplicated in vitro chlo-
roquine resistant falciparum malaria with artemether in
Irian Jaya. Med J Indones 1996;5:33-41.
11. Madiyono B, Moeslichan S, Sastroasmoro S,
Budiman I, Purwanto SH. Perkiraan besar sample.
Sastroasmoro S, Ismael S, editor. Dasar-dasar
metodologi penelitian klinis. 1st ed. Jakarta:
Binarupa Aksara; 1995. p. 187-212.
12. White NJ. The treatment of malaria. N Eng J Med
1996;335:800-06.
13. Rampengan TH. Malaria pada anak. In: Harijanto PN,
editor. Malaria: epidemiologi, patogenesis, manifestasi
klinik, dan penanganan. 1 st ed. Jakarta: EGC; 2000. p.
49-75.
14. Seidlein LV, Bojang K, Jones P, Jaffar S et al. A ran-
domized controlled trial of arthemeter benflumetol,
a new antimalarial and pyrimethamine sulphadoxine
in the treatment of uncomplicated falciparum ma-
laria in Africa children. Am J Trop Med Hyg
1998;58:638-44.
15. Karunajeewa HA, Kemiki A, Alpers MP, Lorry K, Batty
KT, Ilett KF, et al. Safety and therapeutic efficacy of
artesunate suppositories for treatment of malaria in
children in Papua New Guinea. Pediatr Infect Dis J
2003;22:251-5.
16. WHO, Division of Control of Tropical Disease. Man-
agement of uncomplicated malaria and the use of
antimalarial drugs for the protection of travelers.
Report of an Informal Concultion; Geneva; 1995 Sept
18-21.
Published
2016-10-10
How to Cite
1.
Tambajong F, Rampengan T. Comparative efficacy of chloroquine and pyrimethamine-sulfadoxine versus artemether and pyrimethamine-sulfadoxine in the treatment of uncomplicated falciparum malaria in children. PI [Internet]. 10Oct.2016 [cited 23Dec.2024];44(6):228-3. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/783
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Received 2016-10-03
Accepted 2016-10-03
Published 2016-10-10
Accepted 2016-10-03
Published 2016-10-10
