title: Efficacy of chloroquine + sulfadoxine--pyrimethamine, mefloquine + artesunate and artemether + lumefantrine combination therapies to treat Plasmodium falciparum malaria in the Chittagong Hill Tracts, Bangladesh.
abstract: Bangladesh faces growing levels of Plasmodium falciparum resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP). Alternative antimalarial therapies, particularly combination regimens, need to be considered. Therefore, the efficacy of three antimalarial combination therapies was assessed in Chittagong Hill Tracts. A total of 364 P. falciparum patients were recruited and randomly assigned to either CQ + SP, mefloquine + artesunate (MQ + AS) or lumefantrine + artemether (Coartem). Results showed that CQ + SP therapy was less effective than the two artemisinin-based combination therapies. The day 42 PCR-corrected efficacy rate was 62.4% for CQ + SP, 100% for MQ + AS and 97.1% for Coartem. Failures occurred at a shorter interval after CQ + SP treatment than after Coartem. The artemisinin-based therapies effectively prevented development of gametocytes, whereas CQ + SP did not. All three therapies were well tolerated, although reports of mild complaints during treatment appeared higher with MQ + AS. We conclude that CQ + SP is not a viable option for replacing CQ monotherapy as first-line P. falciparum treatment in this area of Bangladesh. A change to artemisinin-based combination therapy is recommended. Both Coartem and MQ + AS appear to be good options, effective in curing P. falciparum malaria and in preventing recrudescences following treatment.
authors.affiliation: MSF-UK, London, UK. ingrid.van.den.broek@london.msf.org
authors.forename: I V
authors.initials: IV
authors.lastname: van den Broek
authors.forename: U A
authors.initials: UA
authors.lastname: Maung
authors.forename: A
authors.initials: A
authors.lastname: Peters
authors.forename: L
authors.initials: L
authors.lastname: Liem
authors.forename: M
authors.initials: M
authors.lastname: Kamal
authors.forename: M
authors.initials: M
authors.lastname: Rahman
authors.forename: M R
authors.initials: MR
authors.lastname: Rahman
authors.forename: A M
authors.initials: AM
authors.lastname: Bangali
authors.forename: S
authors.initials: S
authors.lastname: Das
authors.forename: M
authors.initials: M
authors.lastname: Barends
authors.forename: A M
authors.initials: AM
authors.lastname: Faiz
mesh_terms: D000293:Adolescent; D000962:Antimalarials / Q000008:administration & dosage*; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage; D000077332:Artesunate; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D011739:Pyrimethamine / Q000008:administration & dosage; D012717:Sesquiterpenes / Q000008:administration & dosage; D013413:Sulfadoxine / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D002738:Chloroquine; D000077549:Artemether; D000078102:Lumefantrine; D015767:Mefloquine; D011739:Pyrimethamine