RELATIVE EFFICACY OF ARTESUNATE OR AMODIAQUINE COMBINATION THERAPIES WITH SULPHODOXINE-PYRAMETAMINE IN CHILDREN WITH UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA IN BORNO STATE, NIGERIA

Scientific Research Journal (SCIRJ), Volume I, Issue II, September 2013 37
ISSN 2201-2796
Fig. 3: Effects of parasitamia on PCV in P. falcifarum infected children
treated with a) AT+SP and b) AQ+SP during follow-up period
IV. DISCUSSION
Parasite biomass and temperature at different follow-up periods serves as a strong indicator of drug performance. The present result
revealed rapid fever clearance and parasitological cure with both drugs, however, the high parasite density at enrolment coupled
with faster clearance rate by AT+SP during both early and late phases suggest its higher efficacy over AQ+SP. Previous reports
also rated the Artesunate arm as the most rapid of all available antimalarial drugs in the initial reduction of parasitaemia (Nosten et
al., 2003; Bukirwa et al., 2006; Nahum et al., 2007). The faster speed of Artesunate arm in parasite clearance could be attributed to
its active and potent effects on the early ring stages of plasmodium and early-stage gametocytes shortly after drug administration
(Reichmann et al., 1989). Pharmokinetic studies revealed that Artesunate is rapidly and quantitatively converted in vivo to the
potent active metabolite dihydroartemisinin, which also rapidly and substantially reduces the parasite biomass followed by rapid
resolution of clinical symptoms and reduction of gametocyte carriage (Bloland et al., 2003). However, in spite of the sharp parasite
clearance rate, both Artesunate and Amodiaquine arms have a very short half-life and are rapidly eliminated (Nostenet al., 2003),
which suggests that the combination therapy relied on the Sulphadoxine-Pyrimethermine component at the later phase. Reports
suggest that Sulphadoxine-Pyrimethamine further improved parasitological clearance (Gasasira et al., 2003; Zongoet al., 2007;
Adjeiet al., 2008), but Watkins and Mosobo (1993) pointed out that antifolate arm exert little or no effect on the parasites during
the first 24 hours of their life cycle, while Hyde (1990) reported that even in the late phase it affects only the actively dividing
forms of Plasmodium species (Schizonts).
The present study did not register early treatment failure (ETF) with either of the drugs or late clinical failure (LCF) in AT+SP.
Reported cases of ETF in respect of the drugs are equally low ranging 0-1.7% (Zongo et al., 2005; Blair et al., 2006; Bonnet et al.,
2007; Mukhtar et al., 2007; Ménard et al., 2007; Nahum et al., 2007; Sowunmi et al., 2007). Similarly, reported LCF did not
exceed 5.0% (Gasasira et al., 2003; Zongo et al., 2005; Blair et al., 2006; Faye et al., 2007; Nahum et al., 2007; Ménard et al.,
2007; Mukhtar et al., 2007; Sowunmiet al., 2007). The present result relatively revealed lower frequency of late parasitological
failure (LPF) in AT+SP (8.6%) than AQ+SP (14.9%). Values obtained in the present study fall within the reported ranges of 0 -
10.4% for AT + SP (Nahum et al., 2007, Mukhtar et al., 2007) and 0 - 16% for AQ + SP (Talisuna et al., 2004; Zongo et al., 2005;
Molta et al., 2006; Tagboret al., 2006; Faye et al., 2007; Ménardet al., 2007; Sowunmi et al., 2007). TTF was found to be relatively
higher for AQ+SP (14.96%) than AT+SP (8.6%), the values in other reports were lower with 1.0 - 3.4% occurrence for AT + SP
(Blair et al., 2006, Bonnet et al., 2007) and 2.2% in AQ + SP (Blair et al., 2006). The result on adequate clinical and parasitological
response (ACPR) was in favour of AT+SP with 91.4% compared to 84.5% for AQ+SP. Most reports indicated 91.2 - 99.1% ACPR
for AT + SP (Dorsey et al., 2002, Hamour, 2005, van den Broek et al., 2005, Blair et al., 2006, Bonnet et al., 2007, Nahum et al.,
www.scirj.org
© 2013, Scientific Research Journal