title: Co-trimoxazole compared with sulfadoxine-pyrimethamine in the treatment of uncomplicated malaria in Kenyan children.
abstract: Sulfadoxine-pyrimethamine (SP) and co-trimoxazole were both effective in reducing fever, clearing parasitaemia and improving anaemia in children aged < 5 years with uncomplicated malaria in 2 Kenyan endemic sites, Oyugis in the west and Tiwi on the coast. We compared the efficacy of these 2 regimens (in May-July 1998) by evaluating clinical and parasitological responses over 14 days. The combined incidence of parasitological failure for the combined sites for co-trimoxazole was 14/123 (11%) and for SP 23/145 (16%) (RR 0.72, 95% confidence interval [CI] 0.31-1.46, P = 0.289). The 14-day clinical failure rate for the combined sites for co-trimoxazole was 4/123 (3.3%), and for SP 8/145 (5.5%), (RR 1.69, 95% CI 0.91-3.15, P = 0.129). The results indicate that the risk of treatment failure for the 2 regimens was similar. The antimalarial use of co-trimoxazole in uncomplicated malaria needs further investigation, since the 10-12-h elimination half-life of both components should reduce selective pressure for resistance. In addition, use of a 2-day high-dose course, tested previously, requires further study to demonstrate its efficacy.
authors.affiliation: Centre for Biotechnology Research Development, Kenya Medical Research Institute, P.O. Box 54840, Mbagathi Road, Nairobi, Kenya. s.omar@lshtm.ac.uk
authors.forename: S A
authors.initials: SA
authors.lastname: Omar
authors.forename: A
authors.initials: A
authors.lastname: Bakari
authors.forename: A
authors.initials: A
authors.lastname: Owiti
authors.forename: I S
authors.initials: IS
authors.lastname: Adagu
authors.forename: D C
authors.initials: DC
authors.lastname: Warhurst
mesh_terms: D000208:Acute Disease; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D003128:Coma / Q000188:drug therapy; D004338:Drug Combinations; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D018512:Parasitemia / Q000188:drug therapy; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013413:Sulfadoxine; D011739:Pyrimethamine