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document
Sulfadoxine/pyrimethamine alone or with amodiaquine or artesunate for treatment of uncomplicated malaria : a longitudinal randomised trial . BACKGROUND New antimalarial treatments are urgently needed in sub-Saharan Africa . Improved therapies should decrease failure rates in the short term , but their effect on incidence of subsequent episodes of malaria is little studied . We aimed to compare the short-term and long-term effectiveness of three antimalarial regimens in children from Kampala , Uganda . METHODS We randomly allocated healthy children aged 6 months to 5 years to receive 25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamine plus either placebo , 25 mg/kg amodiaquine , or 12 mg/kg artesunate . Participants were followed up for 1 year and received the same preassigned treatment for every new episode of uncomplicated malaria diagnosed during follow-up . Recrudescent and new infections were distinguished by comparison of polymorphisms in merozoite surface protein 2 ( MSP2 ) . Our primary endpoint was the total number of treatments for malaria per time at risk . Analyses were done per protocol . FINDINGS 183 ( 61 % ) of 316 participants were diagnosed with at least one episode of uncomplicated malaria . A total of 577 episodes of uncomplicated Plasmodium falciparum malaria were treated with study drugs ; all regimens were safe and well tolerated . Clinical treatment failure after 14 days was significantly more frequent in the sulfadoxine/pyrimethamine group ( 38 of 215 , 18 % ) compared with either the sulfadoxine/pyrimethamine plus amodiaquine group ( two of 164 , 1 % ; p < 0.0001 ) or sulfadoxine/pyrimethamine plus artesunate group ( one of 198 , 1 % ; p < 0.0001 ) . After 28 and 42 days , patients in the sulfadoxine/pyrimethamine plus amodiaquine group were significantly less likely to develop malaria than were those in the other groups . Overall , sulfadoxine/pyrimethamine plus amodiaquine reduced the rate of subsequent treatments for malaria by 54 % ( 95 % CI 36-66 , p < 0.0001 ) compared with sulfadoxine/ pyrimethamine alone and by 37 % ( 12-54 , p=0.007 ) compared with sulfadoxine/pyrimethamine plus artesunate . INTERPRETATION Sulfadoxine/pyrimethamine plus amodiaquine could be used as an inexpensive regimen to decrease the rate of subsequent episodes of malaria .
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Intervention_Pharmacological
Sulfadoxine/pyrimethamine alone or with amodiaquine or artesunate
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Intervention_Pharmacological
25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamine plus either
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Intervention_Control
placebo
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Intervention_Pharmacological
, 25 mg/kg amodiaquine , or 12 mg/kg artesunate .
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Outcome_Physical
uncomplicated malaria
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Outcome_Other
failure rates
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Outcome_Physical
total number of treatments for malaria
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Outcome_Other
safe
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Outcome_Other
tolerated
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Outcome_Physical
Clinical treatment failure
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Outcome_Physical
malaria
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Outcome_Physical
rate of subsequent treatments for malaria
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Outcome_Physical
decrease the rate of subsequent episodes of malaria
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Participant_Condition
uncomplicated malaria
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Participant_Age
children
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Participant_Age
6 months to 5 years
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Participant_Sample-size
316