title: Adding artesunate to sulphadoxine-pyrimethamine greatly improves the treatment efficacy in children with uncomplicated falciparum malaria on the coast of Benin, West Africa.
abstract: BACKGROUND
  Benin has recently shifted its national antimalarial drug policy from monotherapies to combinations containing artemisinin derivatives. When this decision was taken, the available information on alternatives to chloroquine and sulphadoxine-pyrimethamine, the first- and second-line treatment, was sparse.
  
  
  METHODS
  In 2003 - 2005, before the drug policy change, a randomized, open-label, clinical trial was carried out on the efficacy of chloroquine, and sulphadoxine-pyrimethamine alone or combined with artesunate, with the aim of providing policy makers with the information needed to formulate a new antimalarial drug policy. Children between six and 59 months of age, with uncomplicated malaria and living in the lagoon costal area in southern Benin, were randomly allocated to one of the three study arms and followed up for 28 days.
  
  
  RESULTS
  Treatment failure (PCR corrected) was significantly lower in the artesunate + sulphadoxine-pyrimethamine group (4/77, 5.3%) than in chloroquine group(51/71, 71.8%) or the sulphadoxine-pyrimethamine alone group (30/70, 44.1%) (p < 0.001). Despite high sulphadoxine-pyrimethamine failure, its combination with artesunate greatly improved treatment efficacy.
  
  
  CONCLUSIONS
  In Benin, artesunate + sulphadoxine-pyrimethamine is efficacious and could be used when the recommended artemisinin-based combinations (artemether-lumefantrine and amodiaquine-artesunate) are not available. However, because sulphadoxine-pyrimethamine is also used in pregnant women as intermittent preventive treatment, its combination with artesunate should not be widely employed in malaria patients as this may compromise the efficacy of intermittent preventive treatment.
authors.affiliation: Laboratoire de Parasitologie, Centre de Recherches Entomologique de Cotonou, Cotonou, Bénin. nahum_alain@yahoo.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Nahum
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.forename: Dorothée
authors.initials: D
authors.lastname: Gazard
authors.forename: Carine
authors.initials: C
authors.lastname: Agbowai
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Overmeir
authors.forename: Harry
authors.initials: H
authors.lastname: van Loen
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Martin
authors.initials: M
authors.lastname: Akogbeto
authors.forename: Marc
authors.initials: M
authors.lastname: Coosemans
authors.forename: Achille
authors.initials: A
authors.lastname: Massougbodji
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000704:Analysis of Variance; D000740:Anemia / Q000139:chemically induced; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077332:Artesunate; D001541:Benin; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016778:Malaria, Falciparum / Q000150:complications / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects*; D011739:Pyrimethamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012141:Respiratory Tract Infections / Q000139:chemically induced; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine