sulfadoxine-pyrimethamine–based combinations for malaria a randomised blinded trial to compare efficacy, safety and selection of resistance in malawi疟疾sulfadoxine-pyrimethamine-based组合随机盲法试验比较疗效,安全性和马拉维的选择电阻.pdfVIP

Sulfadoxine-Pyrimethamine–Based Combinations for Malaria: A Randomised Blinded Trial to Compare Efficacy, Safety and Selection of Resistance in Malawi 1,5 2 2 3 4 David J. Bell *, Suzgo K. Nyirongo , Mavuto Mukaka , Ed E. Zijlstra , Christopher V. Plowe , Malcolm E. 2 1 5 Molyneux , Steve A. Ward , Peter A. Winstanley 1 Department of Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 2 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, 3 Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi, 4 Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America, 5 School of Clinical Sciences, University of Liverpool, Liverpool, United Kingdom Abstract Background: In Malawi, there has been a return of Plasmodium falciparum sensitivity to chloroquine (CQ) since sulfadoxine- pyrimethamine (SP) replaced CQ as first line treatment for uncomplicated malaria. When used for prophylaxis, Amodiaquine (AQ) was associated with agranulocytosis but is considered safe for treatment and is increasingly being used in Africa. Here we compare the efficacy, safety and selection of resistance using SP or CQ+SP or artesunate (ART)+SP or AQ+SP for the treatment of uncomplicated falciparum malaria. Methodology and Findings: 455 children aged 1–5 years were recruited into a double-blinded randomised trial comparing SP to the three combination therapies. Using intention to treat analysis with missing outcomes treated as successes, and without adjustment to distinguish recrudescence from new infections, the day