defining plasmodium falciparum treatment in south west asia a randomized trial comparing artesunate or primaquine combined with chloroquine or sp定义恶性疟原虫在亚洲西南部一个随机试验比较青蒿琥酯治疗或伯氨喹结合氯喹或sp.pdfVIP

Defining Plasmodium falciparum Treatment in South West Asia: A Randomized Trial Comparing Artesunate or Primaquine Combined with Chloroquine or SP 1,2 1,2 2 2 3,4 5 Kate Kolaczinski *, Toby Leslie , Iftikhar Ali , Naeem Durrani , Sue Lee , Marion Barends , Khalid 1 1 1 1 Beshir , Rosalynn Ord , Rachel Hallett , Mark Rowland 1 London School of Hygiene and Tropical Medicine, London, United Kingdom, 2 HealthNet TPO, Peshawar, Pakistan, 3 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 4 Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom, 5 Shoklo Malaria Research Unit, Mae Sot, Thailand Abstract Introduction: Antimalarial resistance has led to a global policy of artemisinin-based combination therapy. Despite growing resistance chloroquine (CQ) remained until recently the official first-line treatment for falciparum malaria in Pakistan, with sulfadoxine-pyrimethamine (SP) second-line. Co-treatment with the gametocytocidal primaquine (PQ) is recommended for transmission control in South Asia. The relative effect of artesunate (AS) or primaquine, as partner drugs, on clinical outcomes and gametocyte carriage in this setting were unknown. Methods: A single-blinded, randomized trial among Afghan refugees in Pakistan compared six treatment arms: CQ; CQ+(single-dose)PQ; CQ+(3 d)AS; SP; SP+(single-dose)PQ, and SP+(3 d)AS. The objectives were to compare treatment failure rates and effect on gametocyte carriage, of CQ or SP monotherapy against the respective combinations (PQ or AS). Outcomes included trophozoite and gametocyte clearance (re