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Baja eficacia de la combinación de artesunato con amodiaquina para el tratamiento de malaria por falciparum no complicada entre niños menores de 5 años en Kailahun, Sierra Leone
Author(s) -
Grandesso Francesco,
Hagerman Andres,
Kamara Sarian,
Lam Eva,
Checchi Francesco,
Balkan Suna,
Scollo Giuseppe,
Durand Rémy,
Guthmann JeanPaul
Publication year - 2006
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2006.01655.x
Subject(s) - amodiaquine , sierra leone , medicine , malaria , artesunate , plasmodium falciparum , tropical medicine , genotyping , pediatrics , surgery , immunology , biology , genotype , biochemistry , pathology , development economics , economics , gene
Summary Objective In 2004, Sierra Leone adopted artesunate plus amodiaquine as first‐line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. Methods Method and outcome classification of the study complied with WHO guidelines. Children 6–59 months with uncomplicated malaria were followed‐up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. Results Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8–99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR‐adjusted day 28 efficacy was 84.5% (95% CI: 76.4–90.7). All true failures occurred in the last 8 days of follow‐up. Of 110 children who completed the 28‐day follow‐up, 54 (49.1%) experienced a novel infection. Conclusion The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone.