title: Treatment history and treatment dose are important determinants of sulfadoxine-pyrimethamine efficacy in children with uncomplicated malaria in Western Kenya.
abstract: This study retrospectively studied amendable determinants of sulfadoxine-pyrimethamine (SP) efficacy involving 2869 treatments among 1072 Kenyan children <5 years old who had uncomplicated malaria. The dose was based on age: one-quarter tablet was given to infants <1 year old, one-half tablet was given to 1-3-year-old children, and a full tablet was given to 4-year-old children. Only 23.5% received the internationally recommended target dose of 25/1.25 mg of SP per kg of body weight. SP intake in the previous 15-35 days (adjusted relative risk, 1.67; 95% confidence interval, 1.35-2.07) and low SP dose (<27.5/1.375 mg/kg) (adjusted relative risk, 1.58; 95% confidence interval, 1.17-2.13) explained 38% of parasitological treatment failures by day 7. Patients with recent SP intake are likely to have recrudescent infections and may need close follow-up if treated with SP or alternative treatment. Applying our weight-for-age data to 31 existing age-based SP dose recommendations predicted that 22 of them would result in underdosing of >25% of children <5 years. Many age-based dose recommendations need urgent revision, because SP is increasingly used as first-line treatment in sub-Saharan Africa.
authors.affiliation: Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
authors.forename: Dianne J
authors.initials: DJ
authors.lastname: Terlouw
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Courval
authors.forename: Margarette S
authors.initials: MS
authors.lastname: Kolczak
authors.forename: Oren S
authors.initials: OS
authors.lastname: Rosenberg
authors.forename: Aggrey J
authors.initials: AJ
authors.lastname: Oloo
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Altaf A
authors.initials: AA
authors.lastname: Lal
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Nahlen
authors.forename: Feiko O
authors.initials: FO
authors.lastname: ter Kuile
mesh_terms: D000367:Age Factors; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use*; D001835:Body Weight; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D006801:Humans; D007223:Infant; D007630:Kenya; D008288:Malaria / Q000188:drug therapy*; D010963:Plasmodium falciparum; D010965:Plasmodium malariae; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000627:therapeutic use*; D012189:Retrospective Studies; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine