부산대학교 도서관

BACKGROUND: Malaria control in Africa is threatened by widespread resistance of Plasmodium falciparum to chloroquine. Combinations of antimalarial agents may increase efficacy and delay drug resistance. OBJECTIVE: To compare the effects of combinations of antimalarial agents on malaria (sulphadoxine/pyrimethamine, amodiaquine and amodiaquine/sulphadoxine/pyrimethamine). SETTING: Kampala, Uganda; September 1999 to July 2000. METHOD: Randomised controlled trial. PARTICIPANTS: Six hundred and sixty-eight people aged over 6 months with malarial symptoms and a positive screening thick blood smear; 58% female; weight over 5 kg; tympanic temperature ≥38.0°C or febrile symptoms in the preceding 48 hours; absence of alternative diagnosis for febrile illness; absence of severe malaria including severe anaemia (packed-cell volume <15%); danger signs (inability to stand or drink, lethargy, convulsions, persistent vomiting). Participants were excluded if they self-administered additional antimalarial drugs during follow-up; concomitant febrile illness emerged; or severe malaria or danger signs developed on the day of leaving the clinic. INTERVENTION: (i) 500 mg sulphadoxine, 25 mg pyrimethamine and placebo; (ii) 200 mg amodiaquine and placebo; or (iii) 25 mg/kg amodiaquine given as 10 mg/kg on days 0 and 1 and 5 mg/kg on day 2, 25 mg/kg sulphadoxine and 1.25 mg/kg pyrimethamine. OUTCOMES: Parasite clearance; resolution of fevers; febrile symptoms. MAIN RESULTS: Parasite clearance was achieved in all three groups, but was highest in the amodiaquine/sulphadoxine/pyrimethamine group . By day 14, fewer people in the amodiaquine/sulphadoxine/pyrimethamine group were parasitaemic.(Table is included in full-text article.) AUTHORS' CONCLUSIONS: Using a combination of antimalarial drugs delays the development of resistance by Plasmodium falciparum and is the most effective alternative to chloroquine in treating malaria.