title: Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan.
abstract: BACKGROUND
  The treatment for Plasmodium falciparum malaria in Sudan has been in process of change since 2003. Preceding the change, this study aimed to determine which artemisinin-based combination therapies is more effective to treat uncomplicated malaria in Malakal, Upper Nile, Sudan.
  
  
  METHODS
  Clinical trial to assess the efficacy of 2 antimalarial therapies to treat P. falciparum infections in children aged 6-59 months, in a period of 42 days after treatment.
  
  
  RESULTS
  A total of 269 children were followed up to 42 days. Artesunate plus Sulfadoxine/Pyrimethamine (AS+SP) and Artesunate plus Amodiaquine (AS+AQ) were both found to be efficacious in curing malaria infections by rapid elimination of parasites and clearance of fever, in preventing recrudescence and suppressing gametocytaemia. The combination of AS+SP appeared slightly more efficacious than AS+AQ, with 4.4% (4/116) versus 15% (17/113) of patients returning with malaria during the 6-week period after treatment (RR = 0.9, 95% CI 0.81-0.96). PCR analysis identified only one recrudescence which, together with one other early treatment failure, gave efficacy rates of 99.0% for AS+AQ (96/97) and 99.1% for AS+SP (112/113). However, PCR results were incomplete and assuming part of the indeterminate samples were recrudescent infections leads to an estimated efficacy ranging 97-98% for AS+SP and 88-95% for AS+AQ.
  
  
  CONCLUSIONS
  These results lead to the recommendation of ACT, and specifically AS+SP, for the treatment of uncomplicated falciparum malaria in this area of Sudan. When implemented, ACT efficacy should be monitored in sentinel sites representing different areas of the country.
authors.affiliation: Manson's Unit, MSF -UK, 67-74 Saffron Hill, London EC1N, UK. ingrid.van.den.broek@london.msf.org
authors.forename: Ingrid
authors.initials: I
authors.lastname: van den Broek
authors.forename: Ribka
authors.initials: R
authors.lastname: Amsalu
authors.forename: Manica
authors.initials: M
authors.lastname: Balasegaram
authors.forename: Pamela
authors.initials: P
authors.lastname: Hepple
authors.forename: Engudaye
authors.initials: E
authors.lastname: Alemu
authors.forename: El Badri
authors.initials: el B
authors.lastname: Hussein
authors.forename: Muhammed
authors.initials: M
authors.lastname: Al-Faith
authors.forename: Jacqui
authors.initials: J
authors.lastname: Montgomery
authors.forename: Francesco
authors.initials: F
authors.lastname: Checchi
mesh_terms: D000655:Amodiaquine / Q000008:administration & dosage* / Q000494:pharmacology; D000962:Antimalarials / Q000008:administration & dosage / Q000494:pharmacology / Q000592:standards*; D037621:Artemisinins / Q000008:administration & dosage* / Q000494:pharmacology; D000077332:Artesunate; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000494:pharmacology; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000494:pharmacology; D013397:Sudan; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D011739:Pyrimethamine
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