TOP
Tuesday,September 29,2020 11:30 AM

Malaria drugs: Which way?

By Vision Reporter

Added 6th December 2004 03:00 AM

Health officials have dismissed two malaria drug combinations recommended by a team of American and Ugandan researchers, as unreliable.

Health officials have dismissed two malaria drug combinations recommended by a team of American and Ugandan researchers, as unreliable.

By Charles Wendo
Health officials have dismissed two malaria drug combinations recommended by a team of American and Ugandan researchers, as unreliable.
The researchers had recommended amodiaquine (camaquine) in combination with either Fansidar (sulfasdoxine-pyrimethamine, SP) or Artesunate to replace Chloroquin and fansidar which are failing to cure malaria because the parasites have grown resistant to them.
The researchers, led by Philip J Rosenthal of the University of California at San Francisco, evaluated various combinations involving chloroquine, SP, amodiaquin and artesunate.
The best combinations were amodiaquin with SP or with artesunate. Their findings were published in the November 27, 2004 issue of The Lancet.
The study, sponsored by the United States National Institutes of Health, was carried out at Mulago Hospital between August 2002 and July 2003. The researchers treated 1,017 children at Mulago Hospital with one of three drug combinations, and then monitored them for 28 days.
The chloroquine-SP combination failed to cure malaria in 13% of the children. This failure rate was considered “unacceptably high”.
The best combination was amodiaquin with artesunate, which cured 98% of the malaria cases. The amodiaquin-SP combination was also successful in 91% of the children.
Whereas the amodiaquine-artesunate combination had a higher cure rate, children got re-infected faster than those who took amodiaquine-SP.
SP lingers in blood for a few weeks after treatment therefore giving a little more protection whereas artesunate is cleared from blood as soon as the job is done.
The researchers estimated that the need to re-treat patients was about the same whether you combine amodiaquin with artesunate or SP. Both combinations were equally acceptable, they concluded.
However, the Manager of Uganda’s Malaria Control Programme, Dr. John Bosco Rwakimari, dismissed the idea of combining SP with amodiaquin. He said though they were planning to change the malaria treatment policy because of the high failure rates of chloroquine and SP, amodiaquin could not be a viable alternative.
“We are not comfortable with that combination of amodiaquin and SP. Both drugs are already facing resistance. If we use that combination we would have to change the treatment policy in two years and changing is very expensive,” he said.
Instead the health ministry plans to change to a combination containing artemether with another drug yet to be identified. Chloroquine will be phased out while SP might still be used in combination with an artemisinin drug. Lumefantrine is another drug being considered for use with artemisinin.
Prof. Francis Omaswa, Director General of Health Services in the Ministry of Health carries out surveys countrywide to measure the effectiveness of anti-malarial drugs. He said that government would change the malaria treatment policy according the resistance patterns detected by the ministry’s own survey and not figures generated by a researcher from one site.
Amir Attaran former adviser of Novartis, a multinational pharmaceutical company, also criticised the findings. In an opinion published in the Lancet, he said the researchers were wrong in equating the SP-amodiaquin combination to that of SP-artesunate. He called the researchers’ argument “unpersuasive” and “qualitatively illogical”.
“A treatment failure means that a sick patient gets sicker - possibly until he or she is dead,” writes Attaran. “A new infection means that the patient returns to clinic for treatment - certainly a bother. Death and bother are highly different. They never balance.”
Ends

Malaria drugs: Which way?

Related articles

More From The Author

More From The Author