Journal Article

Artesunate-Clindamycin versus Quinine-Clindamycin in the Treatment of<i>Plasmodium falciparum</i> Malaria: A Randomized Controlled Trial

Peter G. Kremsner, Michael Ramharter, Sunny Oyakhirome, Peter Klein Klouwenberg, Ayola A. Adégnika, Sélidji T. Agnandji, Michel A. Missinou, Pierre-Blaise Matsiégui, Benjamin Mordmüller, Steffen Borrmann, Jürgen F. Kun, Bertrand Lell, Sanjeev Krishna, Wolfgang Graninger and Saadou Issifou

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 12, pages 1777-1784
Published in print June 2005 | ISSN: 1058-4838
Published online June 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/430309
Artesunate-Clindamycin versus Quinine-Clindamycin in the Treatment ofPlasmodium falciparum Malaria: A Randomized Controlled Trial

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Background. Artemisinin-based drug combinations are the mainstay in the fight against drug-resistant malaria in Africa. Currently available antimalarial drug combinations that include artemisinins are pharmacokinetically unmatched and are therefore potentially increasing the risk of selection of resistant mutants in areas in which the rate of transmission of malaria is high. We tested the potential value of artemisinin-based combination therapy with a short elimination half-life for the treatment of uncomplicatedPlasmodium falciparum malaria in sub-Saharan Africa.

Methods. We conducted an open-label, randomized, controlled clinical trial to evaluate the efficacy and tolerability of oral artesunate-clindamycin therapy given twice daily for 3 days (artesunate, 2 mg/kg, and clindamycin, 7 mg/kg, per dose), compared with a standard quinine-clindamycin regimen given twice daily for 3 days (quinine, 15 mg/kg, and clindamycin, 7 mg/kg, per dose), for the treatment of uncomplicated falciparum malaria in 100 Gabonese children aged 3–12 years. The primary end point of the study was the polymerase chain reaction—corrected cure rate for the per-protocol population.

Results. The activity of artesunate-clindamycin was comparable to that of quinine-clindamycin in the per-protocol analysis of cure rates at day 28 of follow-up (87% versus 94%). No serious adverse events were reported, and tolerability was good and was similar in both groups. Times to clearance of fever and clearance of parasites were significantly shorter in the artesunate-clindamycin group.

Conclusions. Artesunate-clindamycin and other matching artemisinin-based combinations with a short plasma half-life merit further attention for use in regions in which the rate of transmission of malaria is high.

Journal Article.  3802 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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