Efficacies of artesunate plus either sulfadoxine–pyrimethamine or amodiaquine, for the treatment of uncomplicated, Plasmodium falciparum malaria in eastern Sudan

Abstract

Artemisinin-based combination therapy (ACT) is increasingly being adopted as the first-line treatment for malaria in sub-Saharan Africa. In September–November 2005, in New Halfa, eastern Sudan, the efficacy of artesunate–sulfadoxine–pyrimethamine (AS–SP) for the treatment of uncomplicated, Plasmodium falciparum was compared with that of artesunate–amodiaquine (AS–AQ). The artesunate was given at 4 mg/kg. day on days 0–2, with either a single dose of SP (25 mg sulfadoxine/kg) given on day 0, or AQ, at 10 mg/kg. day, given on days 0–2. Eighty-two of the patients treated (40 given AS–SP and 42 given AS–AQ) completed the 28 days of follow-up.

On day 3 all the patients were afebrile and only one patient, in the AS–AQ group, was still parasitaemic. AS–SP appeared slightly more efficacious than AS–AQ but the differences were not statistically significant. Only one patient (2.5%) given AS–SP but four (9.5%) of those given AS–AQ were initially considered to be late treatment and parasitological failures, with all other patients showing an adequate treatment response. The PCR-corrected frequencies of cure were 97.5% for AS–SP and 95.2% for AS–AQ (P>0.05). No gametocytaemias were observed during the follow-up and, although mild adverse effects (nausea, vomiting, abdominal pain, dizziness and/or rash) were detected in 14 patients, they occurred at the same frequency in each treatment arm. It therefore appears that the AS–SP and AS–AQ combinations were both effective and safe for the treatment of uncomplicated, P. falciparum malaria in eastern Sudan.