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Older drugs may be good stopgap treatment for malaria in Africa

complexity and the lack of clinical experience with artemisinin-based combinations," Bukirwa and Critchley say.

The Cochrane reviewers analyzed four studies including 775 malaria patients, children age six months to five years. The studies compared the Fansidar-amodiaquine treatment to Fansidar-artesunate therapy for mild to moderate cases of falciparum malaria.

In three of the studies, the Fansidar-amodiaquine treatment reduced by nearly 40 percent the risk of still having malaria after 28 days of treatment, compared to Fansidar-artesunate treatment.

But the Fansidar-artesunate combination was more than twice as likely as the other drug combination to reduce the number of infectious malaria parasites in the blood to clinically insignificant levels. Reducing the parasite load is important because it reduces the spread of the disease, the reviewers say.

Bukirwa and Critchley stress that the Fansidar-amodiaquine combination should be considered useful and safe only in areas where resistance to both drugs is low. They warn that resistance may have increased since the studies in the review, conducted between 2002 and 2005, were completed.

"It is possible that sulfadoxine-pyrimethamine may not be recommended at all for first-line treatment of any malaria in Africa in the future," Bukirwa said.

Although combination malaria therapies are also being tried in Southeast Asia, where malaria is a major public health problem, the Fansidar-amodiaquine combination is probably not a viable treatment option for that region, says Dr. David Bell, a malaria expert at the University of Liverpool in England.

The failure rates for both amodiaquine and Fansidar "on their own tend to be considerable higher there than when they are used in Africa as monotherapies," he explains. "As such, I don't think the combination of amodiaquine and sulfadoxine-pyrimethamine would even be considered in that setting."

Malaria affects 300 to 5
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Contact: Hasifa Bukirwa
hbukirwa@hotmail.com
Center for the Advancement of Health
24-Jan-2006


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