title: Comparative efficacy of alternative primary therapies for Plasmodium falciparum infections in Malawi.
abstract: In Malawi, where high levels of chloroquine resistance were shown using a modified 7-day in vivo test, amodiaquine and pyrimethamine-sulfadoxine were evaluated as alternative initial therapies for Plasmodium falciparum infections in children under 5 years old. Therapy success rates, judged by parasite clearance by day 7 after initiation of therapy, were significantly greater among 39 children treated with amodiaquine at 10 mg/kg (90%), 37 receiving amodiaquine at 25 mg/kg (97%), and 34 receiving pyrimethamine-sulfadoxine (100%) at a dose of 25 mg sulfadoxine/kg, than among those treated with chloroquine at a dose of 25 mg/kg (59%) (P = 0.01). Extension of the follow-up period of those receiving amodiaquine (25 mg/kg) and pyrimethamine-sulfadoxine to 21 d revealed a progressively increasing rate of parasite recrudescence in the amodiaquine group (34%), but no recrudescence in the pyrimethamine-sulfadoxine group. These results suggest that, in Malawi, amodiaquine and pyrimethamine-sulfadoxine are superior to chloroquine in producing prompt clearance of P. falciparum parasites among young children, and that pyrimethamine-sulfadoxine alone is superior to the 4-aminoquinolines in sustaining P. falciparum clearance.
authors.affiliation: Combatting Childhood Communicable Diseases Program, Ministry of Health, Malawi.
authors.forename: D L
authors.initials: DL
authors.lastname: Heymann
authors.forename: C O
authors.initials: CO
authors.lastname: Khoromana
authors.forename: J J
authors.initials: JJ
authors.lastname: Wirima
authors.forename: C C
authors.initials: CC
authors.lastname: Campbell
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000818:Animals; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D004338:Drug Combinations; D004351:Drug Resistance; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008295:Malawi; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D013424:Sulfanilamides / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; D013424:Sulfanilamides; D000655:Amodiaquine; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine