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Title: Randomized comparison of chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in the Lao People's Democratic Republic
Authors: Mayxay, M; Khanthavong, M; Lindegardh, N; Keola, S; Barends, M; Pongvongsa, T; Yapom, R; Annerberg, A; Phompida, S; Phetsouvanh, R; White, NJ; Newton, PN
Keywords: ANTIMALARIAL-DRUG; EFFICACY; BENFLUMETOL; THAILAND; PHARMACODYNAMICS; PHARMACOKINETICS; COMBINATIONS; MARKERS; TRIAL
Issue Date: 2004
Publisher: CLIN INFECT DIS
Citation: Clin. Infect. Dis.;15-Oct;2004;39;8
Abstract: Background. Recent clinical trials in the Lao People's Democratic Republic have demonstrated that chloroquine and sulfadoxine-pyrimethamine, which are national malaria treatment policy, are no longer effective in the treatment of uncomplicated Plasmodium falciparum malaria. Methods. A randomized comparison of 3 oral antimalarial combinations-chloroquine plus sulfadoxine-pyrimethamine versus artesunate plus mefloquine versus artemether-lumefantrine-with 42-day follow-up period, was conducted among 330 patients with acute uncomplicated falciparum malaria in southern Laos. Results. The 42-day cure rates, as determined by intention-to-treat analysis and adjusted for reinfection, were 100%, 97%, and 93% for the groups receiving artesunate plus mefloquine, artemether-lumefantrine, and chloroquine plus sulfadoxine-pyrimethamine, respectively. Of 8 patients receiving chloroquine plus sulfadoxine-pyrimethamine who experienced treatment failure, 6 had early treatment failure. The mean parasite clearance time was significantly longer in patients treated with chloroquine plus sulfadoxine-pyrimethamine (2.9 days; 95% confidence interval [CI], 2.8-3.0 days) than in those treated with artesunate plus mefloquine (2.07 days; 95% CI, 2.0-2.1 days; P < .001) and artemether-lumefantrine (2.08 days; 95% CI, 2.0-2.1 days; P < .001). Cure rates with artemether-lumefantrine were high despite low mean daily dietary fat intake (13.8 g; 95% CI, 12.5-15.1 g) and day 7 plasma lumefantrine concentrations (0.47 mug/mL; 95% CI, 0.38-0.56 mug/mL). Conclusion. Oral artesunate plus mefloquine and artemether-lumefantrine are highly effective for the treatment of uncomplicated falciparum malaria in Laos.
URI: http://hdl.handle.net/11267/2384
ISSN: 1058-4838

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