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PubMed2001

Preliminary assessment of the efficacy of mefloquine/-sulphadoxine/ pyrimethamine combination in the treatment of uncomplicated malaria in children in North Eastern Nigeria.

Preliminary assessment of efficacy of mefloquine/-sulphadoxine/pyrimethamine (MSP) combination in the treatment of uncomplicated Plasmodium infections was conducted in-vivo in non-immune and semi-immune children in Damboa, in the North east of Nigeria using a 7-day protocol. Six hundred and forty-six (76.4%) subjects out of 846 screened had positive Plasmodium infections. Seventy-two patients aged 6 months to 11 years were enrolled, of whom 69 (95.8%) completed the study. MSP demonstrated high clinical efficacy, producing 100% cure rate against pure P. falciparum (77.8%), pure P. malariae (18.1%) and mixed P. falciparum and P. malariae (4.2%) infections. GMPDs for P. falciparum, P. malariae and mixed infections were 4,826, 3,680 and 12,573 a sexual stages per microl of whole blood. The mean parasite clearance time (MPCT) was 4.42 days for pure P. falciparum parasitaemia and 4.82 days for P. malariae alone. No parasitologic failure occurred in the patients. Clinical response occurred rapidly; all fever cases cleared within 24 hours. Moreover, significant (P<0.05) PCV improvement occurred in 7 days from an average of 33.8 +/- 4.5% on D0 to 35.5 +/- 3.5% on D7. Besides, this drug was well tolerated by majority of patients. Details of these findings are presented and discussed against the background of increased efforts towards effective malaria treatment and control in Nigeria.

Antimalarials↗
PubMed2004

In vivo sulphadoxine-pyrimethamine sentitivity study Tigray Region, Southern Zone, Alamata Town, September--November 2001.

The in vivo therapeutic efficacy of sulfadoxine- pyrimethmanine (SP) was assessed in a clinical setting involving 77 falciparum malaria patients diagnosed at Alamata Sector Laboratory, Southern Tigray in Sept--Nov. 2001. The objective of the study was to ascertain the continued usefulness of SP in the routine treatment of uncomplicated falciparum malaria. The patients were selected among 370 patients, aged 6 months and above, presenting for evaluation of febrile illnesses. The 1996 World Health Organization protocol for assessment of therapeutic efficacy of anti-malarial drugs was employed to select patients fulfilling enrollment criteria. Adequate Clinical Response (ACR) was detected in 75 patients (97.4%) whereas Late Treatment Failure (LTF) was ascribed to the remaining 2 patients ( 2.6% ) This data indicates that SP must have been effective as a first-line treatment for uncomplicated falciparum malaria in Alamata during the survey in 2001. Notwithstanding, the need for continuos surveillance on the therapeutic efficacy of SP as well as the in vitro resistance of P. falciparum is recommended.

Animals↗
PubMed2005

Therapeutic efficacy of sulfadoxine-pyrimethamine for Plasmodium falciparum malaria.

OBJECTIVES: To assess the therapeutic efficacy of sulfadoxinepyrimethamine (SP) after 5 years of use as first-line treatment of uncomplicated Plasmodium falciparum malaria, and thus guide the selection of artemisinin-based combination therapy in Mpumalanga, South Africa. DESIGN: An open-label, in vivo therapeutic efficacy study of patients with uncomplicated P. falciparum malaria treated with a single oral dose of SP, with response to treatment monitored clinically and parasitologically on days 1, 2, 3, 7, 14, 21, 28 and 42. SETTING: Mangweni and Naas public health care clinics, Tonga district in rural Mpumalanga. SUBJECTS, OUTCOME MEASURES AND RESULTS: Of 152 patients recruited sequentially, 149 (98%) were successfully followed up for 42 days. One hundred and thirty-four patients (90%) demonstrated adequate clinical and parasitological response. Of the 15 patients (10%) who failed treatment, 2 (1.3%) had an early treatment failure, and polymerase chain reaction confirmed recrudescent infection in all 13 patients (8.7%) who had late parasitological (N = 11) or clinical (N = 2) failure. Gametocyte carriage was prevalent following SP treatment (84/152) and this has increased significantly since implementation in 1998 (relative risk 2.77 (confidence interval 1.65 - 4.66); p = 0.00004). CONCLUSION: Asexual P. falciparum parasites in Mpumalanga remain sensitive to SP, with no significant difference between the baseline cure rate (94.5%) at introduction in 1998, and the present 90% cure rate (p = 0.14). However, since gametocyte carriage has increased significantly we recommend that SP be combined with artesunate in Mpumalanga to reduce gametocyte carriage and thus decrease malaria transmission and potentially delay antimalarial resistance.

Adolescent↗
PubMed2005

Efficacy of trimethoprim-sulfamethoxazole compared with sulfadoxine-pyrimethamine plus erythromycin for the treatment of uncomplicated malaria in children with integrated management of childhood illness dual classifications of malaria and pneumonia.

In Malawi, trimethoprim-sulfamethoxazole (TS) is the recommended first-line treatment for children with Integrated Management of Childhood Illness dual classifications of malaria and pneumonia, and sulfadoxine-pyrimethyamine (SP) plus five days of treatment with erythromycin (SP plus E) is the recommended second-line treatment. Using a 14-day, modified World Health Organization protocol, children with dual IMCI classifications of malaria and pneumonia with Plasmodium falciparum parasitemia were randomized to receive TS or SP plus E. Clinical and parasitologic responses and gametocytemia prevalence were obtained. A total of 87.2% of children receiving TS and 80.0% receiving SP plus E reached adequate clinical and parasitologic responses (ACPRs) (P = 0.19). Severely malnourished children were less likely to achieve ACPRs than those better nourished (relative risk = 3.34, P = 0.03). Day 7 gametocyte prevalence was 55% and 64% among children receiving TS and SP plus E, respectively (P = 0.19). Thus, TS and SP plus E remain efficacious treatment of P. falciparum malaria in this setting. However, patient adherence and effectiveness of five days of treatment with TS is unknown.

Anti-Infective Agents↗
PubMed2004

Efficacy of sulfadoxin pyrimethamine for uncomplicated Plasmodium falciparum malaria in a small sample of Sudanese children.

A prospective clinical trial was carried out to determine in vivo efficacy of sulfadoxine/pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in children in New Halfa. Forty patients were enrolled; 31 completed the 28-day follow-up. Six (19.4%) patients showed recurrence of parasitaemia during follow-up, while the rest (80.6%) cleared the parasites and responded fully to treatment. All the failures were late treatment failures. Parasite genotyping showed that 1 (16.7%) of the 6 cases of late parasitaemia was due to reinfection while the rest (83.4%) were due to true recrudescence. During the follow-up period 22.6% of patients showed gametocytaemia. The high level of treatment failure as well as gametocytaemia necessitates the introduction of artesunate in this combination therapy.

Adolescent↗
PubMed2005

In vitro processing of donor blood with sulfadoxine-pyrimethamine for eradication of transfusion-induced malaria.

Transfusion-induced malaria is a problem because of the large number of parasites infused and the weakness of transfused patients. Screening of blood donors or treatment of transfused patients or prospective donors does not eliminate this hazard. It is essential to kill the parasite in vitro in the blood of donors before transfusion. A total of 4,484 blood donors were screened for malaria parasite microscopically using the Giemsa staining technique. Only 30 matched the inclusion criteria of this study. Blood samples were divided into four equal samples. Three concentrations of sulfadoxine-pyremthamine (SP) were added to 90 specimens, and none was added to 30 specimens (controls). Blood specimens were then tested by parasitic, biochemical, and hematologic techniques on the day of collection and after 24 and 48 hours of storage in a blood bank refrigerator. The reduction of malaria parasites was proportional to the concentrations of SP and to the storage period. Blood samples without SP had steady number of the parasites. The lethal dose of SP (the dose that killed 99% of the malaria parasites within 24 hours) was 179.65 mug/L and was highly effective within the 24-hour storage period. This dose did not affect constituents of the stored blood. Thus, for eradication of transfusion-induced malaria by in vitro processing of donors blood, SP is a safe and effective drug. It is recommended that optimal doses of SP be added to donated blood prior to phlebotomy.

Adult↗
PubMed2005

Pyrimethamine-sulfadoxine treatment of uncomplicated Plasmodium falciparum malaria in Lao PDR.

A 28-day in vivo treatment trial to evaluate the efficacy of pyrimethamine/sulfadoxine (Fansidar, PS) was conducted in 21 Lao patients with uncomplicated Plasmodium falciparum malaria. Sixteen patients (76%) were completely cured with PS without any reappearance of asexual stage parasitemia during the follow-up examination. On the other hand, 5 patients (24%) failed to respond to this trial medication, resulting in recrudescence of asexual stage P. falciparum malaria. PS resistance resulted in higher prevalence of post-treatment gametocytemia, 25% gametocyte carriers among PS sensitive cases versus 75% of the resistant cases. These findings suggest that although the level of PS resistance is still valid for treatment of malaria in the study area of Lao PDR, post-treatment induction of gametocytemia among resistant cases may result an increase in transmission rate of PS resistant falciparum malaria.

Adolescent↗