Treatment history and treatment dose are important determinants of sulfadoxine-pyrimethamine efficacy in children with uncomplicated malaria in Western Kenya.
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.
Terlouw
Dianne J
DJ
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Courval
Jeanne M
JM
Kolczak
Margarette S
MS
Rosenberg
Oren S
OS
Oloo
Aggrey J
AJ
Kager
Piet A
PA
Lal
Altaf A
AA
Nahlen
Bernard L
BL
ter Kuile
Feiko O
FO
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
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine