Intervention Review

Chlorproguanil-dapsone for treating uncomplicated malaria

  1. Hasifa Bukirwa1,*,
  2. Paul Garner2,
  3. Julia A Critchley3

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 18 OCT 2004

Assessed as up-to-date: 14 AUG 2004

DOI: 10.1002/14651858.CD004387.pub2


How to Cite

Bukirwa H, Garner P, Critchley JA. Chlorproguanil-dapsone for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004387. DOI: 10.1002/14651858.CD004387.pub2.

Author Information

  1. 1

    Makerere University Medical School, Kampala, Uganda

  2. 2

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

  3. 3

    Newcastle University, Institute of Health and Society, Newcastle, Tyne and Wear, UK

*Hasifa Bukirwa, Makerere University Medical School, Mulago Hospital Complex, PO Box 24943, Kampala, Uganda. KGX0@UG.CDC.GOV. hbukirwa@hotmail.com.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 18 OCT 2004

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Using a pilot system we have categorised this review as: Historical question - no update intended. (Please see "Published notes" section of the review for more details).

In Africa, malaria is often resistant to chloroquine and sulfadoxine-pyrimethamine. Chlorproguanil-dapsone is a potential alternative.

Objectives

To compare chlorproguanil-dapsone with other antimalarial drugs for treating uncomplicated falciparum malaria.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (May 2004), CENTRAL (The Cochrane Library 2004, Issue 2), MEDLINE (1966 to May 2004), EMBASE (1988 to May 2004), LILACS (May 2004), Biosis Previews (1985 to May 2004), conference proceedings, and reference lists, and contacted researchers working in this field.

Selection criteria

Randomized and quasi-randomized controlled trials comparing chlorproguanil-dapsone to other antimalarial drugs.

Data collection and analysis

Two reviewers independently applied the inclusion criteria, extracted data, and assessed methodological quality. We calculated the risk ratio (RR) for dichotomous data and mean difference for continuous data, and presented them with 95% confidence intervals (CI).

Main results

Six trials (n = 3352) met the inclusion criteria. Chlorproguanil-dapsone (with 1.2 mg chlorproguanil) as a single dose had fewer treatment failures than chloroquine (1 trial), but more treatment failures and people with parasitaemia at day 28 than sulfadoxine-pyrimethamine (3 trials).

Two trials compared the three-dose chlorproguanil-dapsone (with 2 mg chlorproguanil) regimen with sulfadoxine-pyrimethamine in new attendees. There were fewer treatment failures with chlorproguanil-dapsone by day 7 (RR 0.30, 95% CI 0.19 to 0.49; n = 827, 1 trial) and day 14 (RR 0.36, 95% CI 0.24 to 0.53; n = 1709, 1 trial). Neither trial reported total failures by day 28. A further trial was carried out in participants selected because they had previously failed sulfadoxine-pyrimethamine.

Adverse event reporting was inconsistent between trials, but chlorproguanil-dapsone was associated with more adverse events leading to discontinuation of treatment compared with sulfadoxine-pyrimethamine (RR 4.54, 95% CI 1.74 to 11.82; n = 829, 1 trial). It was also associated with more red blood cell disorders (RR 2.86, 95% CI 1.33 to 6.13; n = 1850, 1 trial).

Authors' conclusions

There are insufficient data about the effects of the current standard chlorproguanil-dapsone regimen (three-dose, 2 mg chlorproguanil). Randomized controlled trials that follow up to day 28, record adverse events, and use an intention-to-treat analysis are required to inform any policy decisions.

2008: We do not plan to update this review because chlorproguanil-dapsone has been withdrawn (see the 'What's new' statement).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Chlorproguanil-dapsone for treating malaria

Chlorproguanil-dapsone was withdrawn in 2008, and the review will not be updated.

Using a pilot system we have categorised this review as: Historical question - no update intended. Please see "Published notes" section of the review for more details.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Chlorproguanildapsone用於無併發症瘧疾之治療

在非洲,瘧疾通常對chloroquine和 sulfadoxinepyrimethamine具抗藥性。Chlorproguanildapsone則是個可能的替代藥組合。

目標

比較chlorproguanildapsone與其他抗瘧藥物對於無併發症惡性瘧疾之治療。

搜尋策略

我們搜尋了Cochrane Infectious Diseases Group Specialized Register (2004年五月), CENTRAL (The Cochrane Library Issue2, 2004年), MEDLINE (1966至2004年五月), EMBASE(1988至2004年五月), LILACS (2004年五月), Biosis Previews (1985至2004年五月),會議報告,以及參考文獻目錄,並聯絡在該領域工作的研究學者。

選擇標準

比較chlorproguanildapsone與其他抗瘧藥物之隨機或準隨機對照試驗。

資料收集與分析

兩位審查員獨立地使用納入標準、擷取資料、以及評估方法學品質。類別變項的數據(dichotomous data)是以相對風險(relative risk, RR)來計算;連續變項的數據(continuous data)則是以加權平均數差(weighted mean difference)來計算,並以95%信賴區間(95% confidence intervals, CI)來表示。

主要結論

共有6個試驗(n = 3352)符合納入標準。使用Chlorproguanildapsone合併(以1.2毫克chlorproguanil)單次劑量比單獨使用chloroquine(1個試驗)有較少的治療失敗,但與使用sulfadoxinepyrimethamine (3個試驗)相較下,在治療第28天有較多的治療失敗及病人出現寄生物血症(parasitaemia)。有2個試驗對3次劑量的chlorproguanildapsone(使用2毫克之chlorproguanil)療程與sulfadoxinepyrimethamine在新得病者之治療做了比較。在第7天時chlorproguanildapsone組有較少的治療失敗(RR 0.30, CI 0.19 to 0.49; n = 827,1 個試驗),在第14天時也有較少的治療失敗(RR 0.36, CI 0.24 to 0.53; n = 1709, 1 個試驗)。但這兩個試驗都沒有在第28天的總失敗率報告。但因部分受試者因為之前使用sulfadoxinepyrimethamine治療失敗,而有進行進一步試驗。不良事件在各個試驗間之報告並不一致,但chlorproguanildapsone與sulfadoxinepyrimethamine相比,前者有較多的導致停藥的不良事件發生(RR 4.54, CI 1.74 to 11.82; n = 829,1個試驗),也有較多的紅血球細胞異常(RR 2.86, CI 1.33 to 6.13; n = 1850, 1 個試驗)。

作者結論

對於目前標準chlorproguanildapsone的療程(3次劑量,2毫克之 chlorproguanil)並無足夠資料可以確認其療效。我們需要有追蹤至第28天的治療,有不良事件記錄,且使用意向分析法(intentiontotreat analysis)的隨機對照試驗,才能提供任何政策上的建議。

翻譯人

本摘要由三軍總醫院洪乃勻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

要有使用chlorproguanildapsone治療瘧疾的政策建議,需要受試者接受更長時間的追蹤及審慎檢視不良反應的其他試驗。Chlorproguanildapsone是既有藥物的一個新組合,且已經用來治療瘧疾。目前的試驗顯示在開始治療後14天在治癒率上確實顯示些許有利證據,但迄今並未有明顯超越sulfadoxinepyrimethamine的優勢。此外,有些證據顯示使用chlorproguanildapsone較常出現嚴重不良反應。