Artesunate+Sulfadoxine-Pyrimethamine for the Treatment of Uncomplicated Falciparum Malaria (ASPF)
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Purpose
In Afghanistan, studies over the past 15 years have shown a high degree of Plasmodium falciparum resistance to chloroquine (80%) and more recently an increasing degree of resistance to sulfadoxine-pyrimethamine monotherapy (12%). In 2003 the high failure rate of chloroquine against falciparum malaria led the national malaria treatment programme to switch its recommended first line drug treatment for uncomplicated Plasmodium falciparum malaria to artemisinin-based combination therapy (ACT) in the form of Artesunate/Sulfadoxine-Pyrimethamine (AS+SP). Second line drug treatment is oral quinine (7 days). The aim of this study is to conduct ongoing monitoring of the efficacy of the new combination against P. falciparum in a group of sentinel sites in Afghanistan.
| Condition | Intervention |
|---|---|
|
Falciparum Malaria |
Drug: artesunate plus sulfadoxine-pyrimethamine (AS+SP) |
| Study Type: | Observational |
| Study Design: | Observational Model: Case-Only Time Perspective: Prospective |
| Official Title: | Efficacy and Safety of Artesunate+Sulfadoxine-Pyrimethamine for the Treatment of Uncomplicated Plasmodium Falciparum Malaria in Malaria Control Centers in Nangarhar, Kunar, Thakhar and Faryab Provinces of Afghanistan |
- Proportion of patients experiencing therapeutic failure [ Time Frame: 42 days ] [ Designated as safety issue: No ]Proportion of patients experiencing therapeutic failure
| Enrollment: | 100 |
| Study Start Date: | March 2010 |
| Study Completion Date: | July 2011 |
| Primary Completion Date: | April 2011 (Final data collection date for primary outcome measure) |
| Groups/Cohorts | Assigned Interventions |
|---|---|
|
falciparum malaria
Febrile children (above six months of age) and non-pregnant adults with confirmed uncomplicated P. falciparum infection
|
Drug: artesunate plus sulfadoxine-pyrimethamine (AS+SP)
artesunate plus sulfadoxine-pyrimethamine (AS+SP)
|
Detailed Description:
The objective of the study is to assess the efficacy and safety of Artesunate/Sulfadoxine-Pyrimethamine (AS+SP) for the treatment of uncomplicated P. falciparum infections in Nangarhar, Kunar, Thakhar, Faryab malaria control centers in Afghanistan.
This is an observational study. Patients will receive the recommended treatment for P. falciparum malaria in Afghanistan (Nangarhar, Kunar, Thakhar, Faryab malaria control centers). The participants will be febrile children above six months of age and non-pregnant adults with confirmed uncomplicated P. falciparum infection. Patients will be treated with AS+SP according to standard dosing regimens. Clinical and parasitological parameters will be monitored over a 42-day follow-up period to evaluate drug efficacy. The study will be conducted during the transmission season of falciparum malaria, i.e. October 2009 to January 2010 and September-December, 2010. Patients will be assessed clinically and via laboratory tests, particularly focussing on whether recurrences are recrudescences of the original infection or reinfections. All bio-medical findings will be recorded in specific patient case record forms and the electronic form of analyzed data as well as a final report will be sent to WHO-Afghanistan and National malaria control program offices for further actions. The patients will receive reasonable transportation costs for follow-up visits as well as one insecticide treated bed-net at the end of enrolment. The results of this study will be used to assist the Ministry of Health of Afghanistan in assessing the current national treatment guidelines for uncomplicated P. falciparum malaria.
Eligibility| Ages Eligible for Study: | 6 Months and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Febrile children (above six months of age) and non-pregnant adults with confirmed uncomplicated P. falciparum infection
Inclusion:
- Age over six months.
- Mono-infection with P. falciparum detected by microscopy at a level of 500-150,000/µL asexual forms
- Presence of axillary or tympanic temperature ≥ 37.5 °C or oral or rectal temperature of ≥ 38 °C or history of fever during the past 24 h;
- ability to swallow oral medication;
- ability and willingness to comply with the study protocol for the duration of the study and to comply with the study visit schedule; and
- Informed consent from the patient or from a parent or guardian in the case of children under 18 years of age.
Exclusion criteria:
- Presence of general danger signs in children aged under 5 years or signs of severe falciparum malaria according to the definitions of the World Health Organization (WHO)
- Mixed or mono-infection with another Plasmodium species detected by microscopy
- Presence of severe malnutrition (defined as a child whose growth standard is below -3 z-score, has symmetrical oedema involving at least the feet or has a mid-upper arm circumference < 110 mm)
- Presence of febrile conditions due to diseases other than malaria (e.g. measles, acute lower respiratory tract infection, severe diarrhoea with dehydration) or other known underlying chronic or severe diseases (e.g. cardiac, renal and hepatic diseases, HIV/AIDS);
- Regular medication, which may interfere with antimalarial pharmacokinetics;
- History of hypersensitivity reactions or contraindications to any of the study medications;
- Female over 12 years of age
Contacts and Locations| Afghanistan | |
| Provincial Malaria Control Centers (MRC) | |
| Maimana, Faryab, Afghanistan | |
| Provincial Malaria Control Centers (MRC) | |
| Asadabad, Kunar, Afghanistan | |
| Provincial Malaria Control Centers (MRC) | |
| Jalalabad, Nangarhar, Afghanistan | |
| Provincial Malaria Control Centers (MRC) | |
| Taloqan, Afghanistan | |
| Principal Investigator: | Ghulam Rahim Awab, MD | Mahidol Oxford Research Unit |
More Information
No publications provided
| Responsible Party: | University of Oxford |
| ClinicalTrials.gov Identifier: | NCT01115439 History of Changes |
| Other Study ID Numbers: | BAKMAL1002 |
| Study First Received: | March 29, 2010 |
| Last Updated: | July 11, 2012 |
| Health Authority: | Afghanistan: Ministry of Public Health |
Keywords provided by University of Oxford:
|
falciparum malaria artemisinin combination treatments |
Additional relevant MeSH terms:
|
Malaria Malaria, Falciparum Protozoan Infections Parasitic Diseases Pyrimethamine Sulfadoxine Artesunate Sulfadoxine-pyrimethamine Antimalarials Antiprotozoal Agents |
Antiparasitic Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Folic Acid Antagonists Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Anti-Infective Agents, Urinary Renal Agents Amebicides |
ClinicalTrials.gov processed this record on May 16, 2013