After 28 days of treatment, there were fewer cases of malaria among children taking a combination of the older sulfadoxine-pyrimethamine (sold under the brand name Fansidar) and amodiaquine than among patients taking a combination of Fansidar and artesunate, a drug based on the newer antimalarial called artemisinin.

However, the Fansidar-artesunate combination was more effective than the other drug combination at clearing malaria parasites from the blood at a particularly infectious stage of parasite development, according to Dr. Hasifa Bukirwa of the Uganda Malaria Surveillance Project and Julia Critchley of the Liverpool School of Tropical Medicine in England.

Bukirwa and Critchley say Fansidar-amodiaquine may be a useful stopgap treatment in areas without access to artemisinin drugs and areas where malaria resistance to Fansidar and amodiaquine is still low.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Artemisinin antimalarials are fast-acting and effective drugs that have proved useful against multi-drug resistant strains of the falciparum type of malaria. The World Health Organization recommends combination therapy that includes artemisinin drugs as the standard treatment in countries where malaria is resistant to older individual drugs such as chloroquine and amodiaquine.

However, "artemisinin drugs are not yet widely available in Africa and may not be for some time because of low production, comparatively high cost, dosing
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Contact: Hasifa Bukirwa
hbukirwa@hotmail.com
Center for the Advancement of Health
24-Jan-2006