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Sulfadoxine-pyrimethamine plus artesunate versus sulfadoxine-pyrimethamine plus amodiaquine for treating uncomplicated malaria

  • Review
  • Intervention

Authors


Abstract

Background

Artemisinin-based combination treatments are strongly advocated, but supplies are limited. Sulfadoxine combined with amodiaquine is an alternative non-artemisinin combination.

Objectives

To compare sulfadoxine-pyrimethamine plus amodiaquine (SP plus AQ) with sulfadoxine-pyrimethamine plus artesunate (SP plus AS) for treating uncomplicated Plasmodium falciparum malaria.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (October 2005), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to October 2005), EMBASE (1988 to October 2005), LILACS (October 2005), and reference lists. We also contacted researchers and organizations working in this field.

Selection criteria

Randomized controlled trials comparing SP plus AS with SP plus AQ for treating uncomplicated P. falciparum malaria.

Data collection and analysis

Two authors independently applied the inclusion criteria, extracted data, and assessed methodological quality. The primary outcome measure was treatment failure (parasitological or clinical evidence of treatment failure between start of treatment and day 28). We calculated the risk ratio (RR) with 95% confidence intervals (CI) for dichotomous data.

Main results

Four trials (775 participants) met the inclusion criteria. All were from areas of high and seasonal malaria transmission in Africa. Fewer participants using SP plus AQ failed treatment by day 28 (RR 0.59, 95% CI 0.42 to 0.83; 652 participants, 3 trials). Even excluding new infections, SP plus AQ performed better (RR 0.62, 95% CI 0.40 to 0.96; 649 participants, 3 trials). There was no statistically significant difference between the two treatments for treatment failure at day 14 (RR 1.14, 95% CI 0.47 to 2.78; 775 participants, 4 trials). SP plus AS was more effective at reducing gametocyte carriage at day seven (RR 2.31, 95% CI 1.36 to 3.92; 220 participants, 1 trial). One trial reported that one person − in the SP plus AQ group − developed severe malaria. Adverse events were poorly reported, but did not seem to differ in type and number between the two treatment combinations.

Authors' conclusions

SP plus AQ performed better at controlling treatment failure at day 28, but was not as good as SP plus AS at reducing gametocyte carriage at day seven. Careful consideration of local resistance patterns is required because resistance to sulfadoxine-pyrimethamine and amodiaquine are high in many areas. In order to delay development of resistance to artesunate, the combination with sulfadoxine-pyrimethamine should only be considered where both drugs are known to be effective. Data on adverse events are still lacking.

摘要

Sulfadoxinepyrimethamine加artesunate與sulfadoxinepyrimethamine加amodiaquine對於治療非重症瘧疾之比較

研究背景

以artemisinin為基礎之組合治療受到強烈建議,但其供應極為有限。Sulfadoxine結合amodiaquine為一種替代性之非artemisinin組合。

研究目的

比較sulfadoxinepyrimethamine加amodiaquine (SP加AQ)與sulfadoxinepyrimethamine加artesunate (SP加AS)對於非重症惡性瘧疾之治療。

检索策略

我們搜尋 Cochrane Infectious Diseases Group Specialized Register (2005年10月)、 CENTRAL (Cochrane Library 2005, Issue 4)、 MEDLINE (1966年– to 2005年10月)、 EMBASE (1988 to 2005年10月)、 LILACS (2005年10月)、以及參考資料清單. 我們也與本領域研究人員以及機構聯絡。

标准/纳入排除标准

比較SP加AS與SP加AQ對於非重症惡性瘧疾之治療的隨機對照試驗。

数据收集与分析

由2名作者獨立應用收錄標準、摘錄數據、並評估方法學品質。主要之結果標準為治療失敗(在治療起始及第28天間之治療失敗的寄生蟲學或臨床證據)。針對二元性數據計算相對風險(relative risk;RR)及95%信賴區間(confidence interval;CI)。

主要结果

共有4項試驗(775名參與者)符合收錄標準。所有此等試驗皆係來自非洲之高及季節性瘧疾傳播區域。較少之使用 SP加AQ的參與者在第28天產生治療失敗的情形(RR 0.59, 95% CI 0.42 to 0.83; 652名參與者,3項試驗)。即使在排除新感染之情形下,SP加AQ仍有較佳之表現(RR 0.62, 95% CI 0.40 to 0.96; 649名參與者,3項試驗)。在第14天時,該兩治療組間並無治療失敗之統計顯著性差異(RR 1.14, 95% CI 0.47 to 2.78; 775名參與者,4項試驗)。在第7天時,SP加AS可較為有效的降低配子體之攜帶量(RR 2.31, 95% CI 1.36 to 3.92; 220名參與者,1項試驗)。其中1項試驗報告,在 SP加AQ組中,其中1名參與者發生了嚴重之瘧疾。不良作用僅受到極少之報告,到在該兩種治療組合之間似乎沒有類型及數量之差異。

作者结论

SP加AQ在第28天時對於控制治療失敗具有較佳之表現,但在第7天時就降低配子體之攜帶量而言並不如 SP加AS。茲須小心考慮局部抗性模式,因為在諸多區域皆存在著高sulfadoxinepyrimethamine及amodiaquine抗性。為延遲產生對於artesunate之抗性,與sulfadoxinepyrimethamine之組合應僅在該兩種藥物皆已知為有效的情形下使應予以考慮。目前仍然缺乏有關不良作用之數據。

Plain language summary

Sulfadoxine-pyrimethamine plus artesunate versus sulfadoxine-pyrimethamine plus amodiaquine for treating uncomplicated malaria

Sulfadoxine-pyrimethamine plus amodiaquine (SP plus AQ) performed better than sulfadoxine-pyrimethamine plus artesunate (SP plus AS) when treating uncomplicated malaria

Malaria is a parasitic disease spread by mosquitoes that kills thousands of people worldwide. Artemisinin-based combination treatments are strongly advocated, but uncertainty about their availability (and cost) remains a major concern. The review includes four small randomized controlled trials, all from Africa, comparing SP plus AS with SP plus AQ for treating uncomplicated malaria. SP plus AQ performed better at destroying blood parasites at 28 days, although resistance to the drugs may have increased since the trials were performed. Adverse events were poorly reported.

概要

就治療非重症瘧疾而言,Sulfadoxinepyrimethamine加amodiaquine (SP加AQ)較sulfadoxinepyrimethamine加artesunate (SP加AS)具有較佳之表現。 瘧疾係一種藉由蚊子傳播之寄生蟲疾病,其在全世界造成很多的死亡病例。以artemisinin為基礎之組合治療受到強烈建議,但其取得之不確定性(及成本)仍為重大的問題。本回顧包括4項小型之隨機對照試驗,其全部皆來自非洲,針對非重症瘧疾之治療比較SP加AS與SP加AQ。SP加AQ在第28天於摧毀血液寄生蟲方面具有較佳之表現,但對於該等藥物之抗性自試驗進行以來已有增加情形。關於不良作用僅有極少之報告。

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