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Extended high efficacy of the combination sulphadoxine-pyrimethamine with artesunate in children with uncomplicated falciparum malaria on the Benin coast, West Africa

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dc.contributor.author Nahum, A.
dc.contributor.author Erhart, A.
dc.contributor.author Ahounou, D.
dc.contributor.author Bonou, D.
dc.contributor.author Van Overmeir, C.
dc.contributor.author Menten, J.
dc.contributor.author Akogbeto, M.
dc.contributor.author Coosemans, M.
dc.contributor.author Massougbodji, A.
dc.contributor.author D'Alessandro, U.
dc.date.accessioned 2009-03-31T13:15:23Z
dc.date.available 2009-03-31T13:15:23Z
dc.date.issued 2009
dc.identifier.issn 1475-2875
dc.identifier.doi http://dx.doi.org/10.1186/1475-2875-8-37
dc.identifier.other ITG-P2A
dc.identifier.other ITG-P5B
dc.identifier.other ITG-I6A
dc.identifier.other ITG-P8A
dc.identifier.other ITG-PLA
dc.identifier.other PARAS
dc.identifier.other U-MALAR
dc.identifier.other U-ENTOM
dc.identifier.other INTER
dc.identifier.other U-CTU
dc.identifier.other ELECTRONIC
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other URL
dc.identifier.other FTA
dc.identifier.other UPD11
dc.identifier.other ABSTRACT
dc.identifier.uri http://hdl.handle.net/10390/2600
dc.description.abstract BACKGROUND: A study carried out in 2003-2005 in Southern Benin showed a day-28 sulphadoxine-pyrimethamine (SP) monotherapy failure rate greater than 40%, while for SP combined with artesunate (SP-AS) the failure rate was 5.3%. Such a large difference could be explained by the relatively short 28-day follow-up period, with a substantial number of recurrent infections possibly occurring after day 28. This paper reports the treatment outcome observed in the same study cohort beyond the initial 28-day follow-up. METHODS: After the 28-day follow-up, children treated with either chloroquine alone (CQ), SP or SP-AS, were visited at home twice a week until day 90 after treatment. A blood sample was collected if the child had fever (axillary temperature > or =37.5 degrees C). Total clinical failure for each treatment group was estimated by combining all the early treatment failures and late clinical failures that occurred over the whole follow-up period, i.e. from day 0 up to day 90. Pre-treatment randomly selected blood samples were genotyped for the dhfr gene (59) and the dhps gene (437 and 540) point mutations related to SP resistance. RESULTS: The PCR-corrected clinical failure at day 90 was significantly lower in the SP-AS group (SP-AS: 2.7%, SP alone: 38.2%; CQ: 41.1%) (Log-Rank p < 0,001). The most prevalent haplotype was dhfr Arg-59 with the dhps Gly-437 mutant and the dhps 540 wild type (85.5%). The dhps 540 mutation could be found in only three (8.3%) samples. CONCLUSION: Combining artesunate to SP dramatically increased the treatment efficacy, even when extending the follow-up to day 90 post-treatment, and despite the high percentage of failures following treatment with SP alone. Such a good performance may be explained by the low prevalence of the dhps 540 mutation, by the rapid parasite clearance with artesunate and by the level of acquired immunity. en
dc.language English en
dc.publisher BioMed Central en
dc.subject Protozoal diseases en
dc.subject Malaria en
dc.subject Children en
dc.subject Drug therapy en
dc.subject Antimalarials en
dc.subject Monotherapy en
dc.subject Chloroquine en
dc.subject Sulfadoxine-pyrimethamine en
dc.subject Artemisinin combination therapies (ACT) en
dc.subject Treatment outcomes en
dc.subject Long term en
dc.subject Mutations en
dc.subject Acquired immunity en
dc.subject Benin en
dc.subject Africa, West en
dc.title Extended high efficacy of the combination sulphadoxine-pyrimethamine with artesunate in children with uncomplicated falciparum malaria on the Benin coast, West Africa en
dc.type Article-E en
dc.citation.issue 37 en
dc.citation.jtitle Malaria Journal en
dc.citation.volume 8 en
dc.citation.pages 12 pp. en
dc.publisher.place London
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/19257898
dc.identifier.url http://www.malariajournal.com/content/8/1/37
dc.citation.jabbreviation Malar J en


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